The growth of medicine from the earliest times to about 1800

,^^^

THE GROWTH OF MEDICINE
FROM THE EARLIEST TIMES TO ABOUT 1800

'^v

Published on the Foundation
Established in Memory of

WILLIAM CHAUNCEY WILLIAMS
OF THE Class of 1822, Yale Medical School

AND OF

WILLIAM COOK WILLIAMS
OF THE Class of 1850, Yale Medical School

y.

-^

THE GROWTH OF MEDICINE ^

FROM THE EARLIEST TIMES
TO ABOUT 1800

By
ALBERT H. BUCK, B.A., M.D.

Formerlv Clinical Professor of Diseases of the Ear, Columbia

University, New York — Consulting Aural Surgeon,

New York Eye and Ear Infirmary; etc.

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NEW HAVEN: YALE UNIVERSITY PRESS

LONDON: HUMPHREY MILFORD

OXFORD UNIVERSITY PRESS

MDCCCCXVII

4v

Copyright, 1917
By Yale University Press

First published, February, 1917

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THE WILLIAMS MEMORIAL PUBLICATION

FUND

The present volume is the first work published by the
Yale University Press on the Williams Memorial Publica-
tion Fund. This Foundation was established June 15, 1916,
by a gift made to Yale University by Dr. George C. F.
Williams, of Hartford, a member of the Class of 1878, Yale
School of Medicine, where three generations of his family
studied — his father, William Cook Williams, in the Class
of 1850, and his grandfather, William Chauncey Williams,
in the Class of 1822.

^v^^

/i

PREFACE

Very few persons will challenge the truth of the state-
ment that in the United States and Canada there are not
many physicians who possess even a slight knowledge
concerning the manner in which the science of medicine
has attained its present power as an agency for good, or
concerning the men who played the chief parts in bringing
about this great result. Up to the present time no blame
may justly be attached to any individuals or to any educa-
tional institutions for this prevailing lack of knowledge,
and for two very good reasons, viz. : first, in a newly settled
country, in which the population grows by leaps and
bounds through the influx of foreign immigrants, the train-
ing of young men for the degree of M.D. must necessarily
be almost entirely of a practical character, and conse-
quently the teaching of such a subject as the history of
medicine would be quite out of place; and, second, the
treatises on this subject which are purchasable by English-
speaking physicians are of rather too scientific a character
to appeal either to the undergraduate or to the busy
practitioner. The first of the reasons named, it may now
safely be assumed, is rapidly losing its validity, if indeed
it has not already ceased entirely to afford a legitimate
excuse for neglecting the study of this branch of medical
science. On the other hand, the second reason mentioned
is still in force, — so far at least as the present writer
knows, — and, if such be the case, it certainly cannot fail
to act as a deterrent influence of great potency. Here,
then, is my apology for attempting to prepare an account
of the history of medicine which shall present the essential
facts truthfully and with a sufficient degree of attractive-
ness to win the continuing interest of the reader; which
shall place before him, and especially before those who
are just at the threshold of their professional career,
word pictures of those physicians of past ages whose lives

X PREFACE

may safely be taken as models worthy to be copied; and
which shall describe, so far as I am able to do this, the
methods which they employed to advance the science of
medicine, to gain genuine professional success, and to
merit the enduring esteem of later generations of physi-
cians. If my efforts prove successful in producing this
kind of history it is fair to expect that, in a comparatively
short time, those physicians whose interest may have been
aroused by the perusal of this less complete and more
popular work, will demand something of a more exhaustive
character — a book, for example, like the admirable history
which Max Neuburger, of Vienna, is now publishing, and
of which two volumes have already issued from the press
(the first in 1906 and the second in 1911)/ It is to this
work and the excellent history written by the late Dr.
Haeser, of Breslau, that I am chiefly indebted for the
information supplied in these pages ; and I therefore desire
to make special mention here of this indebtedness. The
other sources from which I have been an occasional
borrower are all mentioned in the ''List of Authorities
Consulted." Footnotes and cross-references in the text
interfere greatly with one's pleasure in reading a book,
and I have therefore not hesitated to introduce them
sparingly.

It gives me a special pleasure to call attention here to
the far-sighted generosity displayed by the founder of
The Williams Memorial Fund in making it practicable
henceforth for the Yale University Press to accept for
publication medical treatises which deal with the historical
and scientific questions of this branch of knowledge, but
which for sound business reasons cannot be published on
a merely commercial basis.

And I have the further pleasure of expressing my real
appreciation of the skill with which the University Press
has solved the problems of a suitable size and style of type

1 A third volume is in course of preparation, but the probable date of its
publication has not been announced. An English translation of the first
volume (by Ernest Playfair) was published by Hodder and Stoughton, of
London, in 1910.

PREFACE ' xi

for this volume, and of the sound advice which it has given
with regard to the extent to which the effectiveness of the
book may be increased by the introduction of pictorial
illustrations.

To my friend, Lawrence F. Abbott, of New York, I am
deeply indebted for the valuable assistance which he has
rendered me throughout the entire progress of this work.
Indeed, without this assistance, I doubt whether I should
have had the courage to remain at my post to the very end.

Albert H. Buck.
Cornwall, N. Y., December 29, 1916.

CONTENTS
PART I. ANCIENT MEDICINE

PAGE

Preface ix

Chapter I. Development of the Science and Art of

Medicine ........ 3

Chapter II. Oriental Medicine ..... 13

Chapter III. Oriental Medicine (continued) . . .25

Chapter IV. Greek Medicine at the Dawn of History . 46

Chapter V. The Significance of the Serpent in the
Statues and Votive Offerings Exposed to View in
the Aesculapian Temples ..... 62

Chapter VI. The Beginnings of a Rational System of

Medicine in Greece ...... 67

Chapter VII. Hippocrates the Great .... 81

Chapter VIII. Brief Extracts from Some of the Hip-

pocratic Writings ...... 89

Chapter IX, The State of Greek Medicine after the
Events of the Peloponnesian War; the Founding of
Alexandria in Egypt, at the Mouth of the Nile; and
the Development of Different Sects in Medicine . 96

Chapter X. Erasistratus and Herophilus, the Two Great
Leaders in Medicine at Alexandria; the Founding
of New Sects 104

Chapter XI. Asclepiades, the Introducer of Greek Medi-
cine into Rome ....... 116

Chapter XII. The State of Medicine at Rome after the
Death of Asclepiades; the Founding of the School
of the Methodists 129

Chapter XIII. The Further History of Methodism at
Rome, and the Development of Two New Sects, viz.,
the Pneumatists and the Eclectics. — A General Sur-
vey of the Subject of Sects in Medicine . . . 138

xiv CONTENTS

PAGE

Chapter XIV. Well-known Medical Authors of the Early

Centuries of the Christian Era .... 151

Chapter XV. Claudius Galen . . . . .160

Chapter XVI. The Influence of Christianity upon the

Evolution of Medicine 179

PART II. MEDIAEVAL MEDICINE

Chapter XVII. The Condition of Medicine at Byzantium

during the Early Part of the Middle Ages . . 191

Chapter XVIII. Beginning of the Arab Renaissance under

the Caliphs of Bagdad . . . . . .203

Chapter XIX. Further Advance of the Arab Renaissance
during the Ninth and Succeeding Centuries of the
Christiiin Era . . . . . . .212

Chapter XX. Hospitals and Monasteries in the Middle

Ages 235

Chapter XXI. Medical Instruction at Salerno, Italy, in

the Middle Ages 243

Chapter XXII. Early Evidences of the Influence of the
Renaissance upon the Progress of Medicine in West-
ern Europe ....... 259

Chapter XXIII. Further Progress of Medicine and Sur-
gery in Western Europe during the Thirteenth,
Fourteenth and a Part of the Fifteenth Centuries . 269

Chapter XXIV. During the Latter Half of the Middle
Ages Surgery Assumes the Most Prominent Place
in the Advance of Medical Science . . . . 292

Chapter XXV. Brief History of the Allied Sciences —

Pharmacy, Chemistry and Balneotherapeutics . . 315

PART III. MEDICINE DURING THE RENAISSANCE

Chapter XXVI. Important Events that Preceded the
Renaissance — Early Attempts to Dissect the Human
Body 327

CONTENTS XV

PAGE

Chapter XXVII. The Founders of Human Anatomy and

Physiology ....... 340

Chapter XXVIII. Further Details Concerning the Ad-
vance in Our Knowledge of Anatomy. — Dissecting
Made a Part of the Regular Training of a Medical
Student. — latrochemists and latrophysicists. — The
Employment of Latin in Lecturing and "Writing on
Medical Topics 355

Chapter XXIX. The Contributions Made by Different
Men during the Renaissance, and More particularly
by William Harvey of England, to Our Knowledge
of the Circulation of the Blood, Lymph and Chyle . 371

Chapter XXX. Advances Made in Internal Medicine and
in the Collateral Branches of Botany, Pharmacology,
Chemistry and Pathological Anatomy . . . 387

Chapter XXXI. Chemistry and Experimental Pharma-
cology ........ 398

Chapter XXXII. Some of the Leaders in Medicine in
Italy, France and England during the Sixteenth and
Seventeenth Centuries ...... 411

Chapter XXXIII. The Three Leading Physicians of Ger-
many during the Latter Half of the Seventeenth Cen-
tury: Franz de le Boe Sylvius, Friedrich Hoffmann
and Georg Ernst Stahl 426

Chapter XXXIV. Hermann Boerhaave of Leyden, Hol-
land, one of the Most Distinguished Physicians of
the Seventeenth Century ..... 438

Chapter XXXV. General Remarks on the Development of
Surgery in Europe during the Fifteenth and Six-
teenth Centuries . . . . . . 446

Chapter XXXVI. Surgery in Germany and Switzerland

during the Fifteenth and Sixteenth Centuries . . 454

Chapter XXXVII. The Development of Surgery in Italy

during the Renaissance ..... 472

Chapter XXXVIII. The Development of Surgery in

Spain and Portugal during the Renaissance . . 484

xvi CONTENTS

PAGE

Chapter XXXIX. The Development of Surgery in France

during the Renaissance. — Pierre Franco . . . 490

Chapter XL. The Development of Surgery in France

(continued). — Ambroise Pare .... 499

Chapter XLI. Surgery in Great Britain during the Six-
teenth and Seventeenth Centuries .... 516

Chapter XLII. Reforms Instituted by the Italian Surgeon
Magati in the Treatment of Wounds. — Final Ending
of the Feud between the Surgeons and the Physicians
of Paris. — Revival of Interest in the Science of
Obstetrics 529

Chapter XLIII. The First Appearance of Syphilis in
Europe as an Epidemic Disease. — Medical Journal-
ism.— The Beginnings of a Modern Pharmaco-
poeia.— Itinerant Lithotomists .... 542

List of the More Important Authorities Consulted . . 557

General Index ........ 563

LIST OF ILLUSTRATIONS

Fig. 1. View of the Temple of Aesculapius on the Island

of Cos ..... facing page 52

Fig. 2. Bird's-eye View of the Temple of Aesculapius
and Associated Buildings on the Island of Cos

facing page 54

Fig. 3. Ground Plan of the Asclepieion on the Island

of Cos ..... facing page 55

Fig. 4. Ancient Statue of the God Aesculapius in the

Berlin Museum .... facing page 62

Fig, 5. Head of the Marble Statue of the God Aesculapius

in the Naples Museum . . facing page 62

Fig. 6. Bas-relief of Aesculapius, Accompanied by-
Women and Children, in the Presence of an
Enormous Serpent . . . facing page 68

Fig. 7. Female Bust Showing Cancer of One Breast

facing page 68

Fig. 8, Paralysis of the Left Facial Nerve . facing page 70

Fig. 9. The Oldest Known Pictorial Representation of a
Formal Dissection of the Human Body

facing page 280

Fig. 10. The Manner of Giving Public Instruction in

Medicine during the Middle Ages . . .281

Fig. 11. Henri de Monde ville . . . facing page 288

Fig. 12. One of the Wards in the Hotel-Dieu of Paris

facing page 304

Fig. 13. The Physician, the Surgeon and the Pharmacist

facing page 306
Fig. 14. Andreas Vesalius . . . . facing page 344

Fig. 15. William Harvey .... facing page 380
Fig. 16. "The Lovesick Maiden" . . . facing page 412

Fig. 17. Thomas Sydenham . . . facing page 418

xvin LIST OF ILLUSTRATIONS

Fig. 18. Consultation by Three Physicians upon a Case

of Wound in the Chest . . . .457

Fig, 19. Barber Surgeon (Wundarzt) Extracting an
Arrow from a Wounded Soldier's Chest while
the Battle is Still in Progress . . . 461,

Fig. 20. Amputation of the Leg 463

Fig. 21. The Manner in Which the So-called Tagliacotian
Operation for Repairing a Defective Nose
Should be Carried Out . . . .480

Fig. 22. Pierre Franco's Forceps for Crushing Calculi in

the Urinary Bladder ..... 497

Figs. 23-24. Forceps Devised in 1552 by Ambroise Pare for
Drawing Out the Cut Ends of Arteries after
the Amputation of a Limb, and Holding Them
while the Ligature is Being Applied . . 512

Fig. 25. Ambroise Pare, the Famous French Surgeon of

the Sixteenth Century , . facing page 514

Fig. 26. Frere Jacques de Beaulieu . . facing page 550

Fig. 27. Jean Baseilhac, commonly Known in France as

Frere Come .... facing page 552

Fig. 28. Concealed Lithotome Invented by Frere Come in

1748 553

PART I
ANCIENT MEDICINE

CHAPTER 1

DEVELOPMENT OF THE SCIENCE AND ART
OF MEDICINE

Friedlaender says that *4n the temple of history, now
hoary with age, medicine also possesses its own chapel,
not an accidental addition to the edifice but a large and
important part of the noble building." In this chapel is
preserved the record of the efforts made by man, through
the ages, to maintain his body in good condition, to restore
it to health when it has become affected by disease or
damaged by violence, and to ward off the various maladies
to which it is liable. It is a record, therefore, in which
every practitioner of medicine should take a deep interest.
Rokitansky, the famous pathologist of Vienna, expressed
the same idea very tersely when he said: ** Those about
to study medicine and the younger physicians should light
their torches at the fires of the ancients." Members of the
medical profession, however, are not the only persons in
the community who take an interest in the origin and
growth of the science of medicine and the art of healing
the diseased or damaged body ; the educated layman is but
little less interested than the physician, being ever ready
to learn all he can about the progress of a branch of knowl-
edge which so profoundly affects his welfare. But hitherto
the only sources of information available for those who are
not familiar with French or German have been treatises of
so technical a character that even physicians have shown
relatively little disposition to read them.

The science of medicine developed slowly from very
humble beginnings, and for this earliest period the historian
has no records of any kind which may be utilized for his

4 GROWTH OF MEDICINE

guidance. It is reasonably certain, furthermore, that this
prehistoric period lasted for a very long time, probably
several thousand years; and when, finally, some light on
the subject appeared, it was found to emanate from several
widely separated regions — e.g., from India, Mesopotamia,
Egypt and Greece. Then, after the lapse of additional
hundreds or even thousands of years, there was inaugurated
the practice of making written records of all important
events, and, among others, of the different diseases which
affect mankind, of the means employed for curing them or
for relieving the effects which they produce, and of the men
who distinguished themselves in the practice of this art.
While the ''science of the spade" and that of deciphering
the writing of the papyri, monuments and tablets thus
brought to light, have already during the last half century
greatly altered our ideas with regard to ancient medicine,
there are good reasons for believing that much additional
information upon this subject may be looked for in the not
distant future. It is plain, therefore, that a history of the
primitive period of medicine, if written to-day, may have
to be modified to-morrow in some important respects. On
the other hand, the facts relating to the later periods are
now so well established that a fair-minded writer should
experience no serious difficulty in judging correctly with
regard to their value and with regard to the claims of the
different men to be honored for the part which each has
played in bringing the science and art of medicine to their
present high state of completeness and efficiency.

The subdivision of the history of medicine into separate
periods is certainly desirable, provided it be found prac-
ticable to assign reasonably well-defined limits to the
periods chosen. But, when the attempt is made to establish
such subdivisions, one soon discovers that the boundaries
pass so gradually the one into the other at certain points,
or else overlap so conspicuously at other points, that one
hesitates to adopt any fixed plan of classification. Of
the four schemes which I have examined — viz., those of
Daremberg, of Aschoff, of Neuburger, and of Pagel — that
of Neuburger seems to me to be the best. That which has

BEGINNINGS OF MEDICINE 5

been adopted, however, in the preparation of the present
outline sketch combines some of the features of both the
Pagel and the Neuburger schemes.

Periods in the History of Medicine. — There are nine
more or less distinctly defined periods in the history of
medicine, to wit: —

First Epoch : Primitive medicine. — This period extends
through prehistoric ages to a date which differs for
different parts of the world. The duration of this period,
in any case, is to be reckoned by thousands of years.

Second Epoch: The medicine of the East — that is, of
the cultivated oriental races of whose history we possess
only a very fragmentary knowledge.

Third Epoch: The medicine of the classical period of
antiquity — the pre-Hippocratic period of Greek medicine.

Fourth Epoch : The medicine of the Hippocratic writ-
ings— the most flourishing period of Greek medicine.

Fifth Epoch : The medicine of the period during which
the centre of greatest intellectual activity was located at
Alexandria, Egypt.

Sixth Epoch : The medicine of Galen — an author whose
teachings exerted a preponderating influence upon the
thought and practice of physicians in every part of the
civilized world up to the seventeenth century of the
Christian era. This period is also characterized by the
gradual diminution of the influence of Greek medicine.

Seventh Epoch: The medicine of the Middle Ages — a
period which includes a large part of the preceding epoch.
Its most characteristic feature is the important part played
by the Arabs in moulding the teachings and practice of the
medical men of that time (ninth to fifteenth century).

Eighth Epoch (fifteenth and sixteenth centuries) : The
medicine of the Renaissance period — characterized chiefly
by the adoption of the only effective method of studying
the anatomy of man — the actual dissection of human bodies.

Ninth Epoch (from the beginning of the seventeenth
century to the present time) : Modern medicine. — This
epoch may with advantage be divided into two periods —
the first extending to about the year 1775, soon after which

6 GROWTH OF MEDICINE

time Jenner began Ms important work on the subject of
vaccination; and the second to the present time. No
attempt will be made in the following account to cover this
second period.

The Beginnings of Medicine. — In the early period of
man's existence upon this earth he must have possessed
an exceedingly small stock of knowledge with regard to
the maintenance of his body in health and with regard to
the means which he should adopt in order to restore it to
a normal condition after it had been injured by violence
or impaired in its working machinery by disease. With the
progress of time, utilizing his powers of observation and
his reasoning faculty, he slowly made additions to his stock
of facts of this nature. Thus, for example, he gradually
learned that cold, under certain circumstances, is competent
to produce pain in the chest, shortness of breath, active
secretion of mucus, etc., and his instinct led him, when he
became affected in this manner, to crave the local appli-
cation of heat as a means of affording relief from these
distressing symptoms. Again, when he used certain plants
as food he could scarcely fail to note the facts that some
of them produced a refreshing or cooling effect, that others
induced a sensation of warmth, and finally that others still,
by reason of their poisonous properties, did actual harm.
Sooner or later, such phenomena as nausea, vomiting and
diarrhoea would also be attributed by him to their true
causes. In due course of time his friends and neighbors,
having made similar observations and having tried various
remedial procedures for the relief of their bodily ills, would
come together and compare with him their several expe-
riences; and so eventually the fact would be brought out
that the particular method adopted by one of their number
for the relief of certain symptoms had proved more
effective than any of the others. Thus gradually this
isolated community or tribe of men must have learned how
to treat, more or less successfully, the simpler ills to which
they were liable.

Lucien Le Clerc quotes from the Arab historian Ebn Abi
Ossaibiah the following account of the manner in which

BEGINNINGS OF MEDICINE 7

bloodletting probably first came to be adopted as a remedial
measure : —

Let us suppose that in the earliest period of man's history some-
body experienced the need of the medical art. He may, for
example, have felt a general sense of heaviness in his body
(plethora), associated perhaps with redness of the eyes, and he
probably did not know what he should do in order to obtain relief
from these sensations. Then, when his trouble was at its worst,
his nose began to bleed, and the bleeding continued until he
experienced decided relief from his discomfort. In this way he
learned an important fact, and cherished it in his memory.

On a later occasion he experienced once more the same sense
of heaviness, and he lost no time in scratching the interior of his
nose in order to provoke a return of the bleeding. The nose-
bleed thus excited again gave him entire relief from the unpleasant
sensations, and upon the first convenient occasion he told his
children and all his relatives about the successful results obtained
from this curative procedure. Little by little this simple act,
which was a first step in the healing art, developed into the
intelligently and skilfully performed operation of venesection.

Primitive man also increased bis stock of knowledge in
the healing art by reading attentively the book of nature, —
i.e., by observing how animals, when ill, eat the leaves or
stems of certain plants and thus obtain relief from their
disorders. The virtues of a species of origanum, as an
antidote for poisoning from the bite of a snake, were
revealed, it is asserted, by the observation that turtles,
when bitten by one of these reptiles, immediately seek for
the plant in question and, after feeding upon it, experience
no perceptible ill effects from the poisonous bite. The
natives of India ascribe the discovery of the remarkable
virtues of snakeroot (the bitter root of the ophiorrhiza
Mungos) as an antidote for poisoning by the bite of a snake,
to the ichneumon, a small animal of the rat species. The
instinctive desire to escape pain taught man, as it does the
lower animals, to keep a fractured limb at rest, thus giving
the separated ends of the bone an opportunity to reunite;
after which the limb eventually becomes as strong as it
ever was. Simple as this mode of acquiring useful medical

8 GROWTH OF MEDICINE

knowledge may appear to us moderns, there are good
reasons for believing that hundreds of years must have
elapsed before the accumulated stock of such experiences
became really considerable. On the other hand, it is
reasonable to suppose that this growth in medical knowl-
edge took place more rapidly in certain tribes or races than
in others, and that when, under the action of wars, the
inferior men became tributary to those of greater intel-
lectual powers, they acquired, through contact with their
conquerors, additional knowledge at a much more rapid
rate. One great hindrance, however, stood in the way of
such progress. I refer to the deeply rooted belief, enter-
tained by man in this primitive period of his existence, in
the agency of malevolent spirits (demons) in the production
of disease, — a belief which continued to exist for many
thousands of years. Out of such a belief developed the
necessity of discovering some practical method of appeasing
the evil spirits and of thus obtaining the desired cure of
the ills of the body. Usually some member of the tribe
who had displayed special skill in the treatment of disease,
and who at the same time was liberally endowed with the
qualities which characterize the charlatan, was chosen to
be the priest or ''medicine man." It was his duty to
employ measures suitable for expelling the demon from
the patient's body and for restoring the latter to health.
Possessing great influence, as these superstitious people
believed he did, with the unseen gods, such a physician-
priest must have discouraged all efforts to increase the
stock of genuine medical knowledge; for such an increase
would necessarily mean a diminution of his own power
and influence.

In what must still be termed the age of primitive medi-
cine, but undoubtedly at an advanced stage of that epoch,
there were performed surgical operations which imply a
remarkable advance in the invention of cutting instruments
and in the knowledge of the location and nature of certain
comparatively rare diseases, and at the same time great
courage and wonderful enterprise on the part of those
early physicians. As evidence of the correctness of these

BEGINNINGS OF MEDICINE 9

statements the fact may be mentioned that trepanned skulls
belonging to the neolithic period have been dug up in
various parts of the world — in most of the countries of
Europe, in Algiers, in the Canary Islands, and in both
North and South America. From a careful study of these
skulls it has been learned that the individuals upon whom
such severe surgical work had been done — sometimes as
often as three separate times — recovered from the opera-
tion. The instruments used were made of sharpened flint
(saws or chisels). Pain in the head, spasms or convulsions,
and mental disorders are suggested by Neuburger as the
indications which probably led to the performance of the
trepanning. This author also makes the further statement
that the ancient Egyptians employed knives made of flint
for opening the dead bodies which they were about to
embalm and for the operation of circumcision. Recent
excavations have thrown additional light upon the state
of medical knowledge during this neolithic age. Thus,
there have been found specimens of anchylosed joints, of
fractured bones, of flint arrow heads lodged in different
parts of the skeleton, of rhachitis, of caries and necrosis
of bone, etc. The following quotation is taken from the
printed report of a lecture recently delivered in London
by Dr. F. M. Sandwith, Consulting Surgeon to the Khedive
of Egypt. Speaking of certain excavations made in the
Nubian Desert and of the oldest surgical implements yet
discovered, he says : —

In one place a graveyard was found, and here were remains of
bodies with fractured limbs that had been set with bark splints.
One was a right thigh bone that had been broken, and was still
held in position by a workmanlike splint and bandages. All the
knots were true reef-knots, and the wrappings showed how the
strips of palm-fibre cloth were set just as a good surgeon would
set them in these days so as to use the full strength of the fabric.

Among the most ancient remedies may be mentioned
talismans, amulets and medicine stones, which were fur-
nished— presumably at a price — by the physician-priests,
and which were believed to afford the wearers protection

10 GROWTH OF MEDICINE

against evil spirits (the **evil eye," for example). Various
objects were used for this purpose, and among them the
following deserve to be mentioned : disks of bone removed
with the aid of a trephine from the skull of a dead human
body and worn with a string around the neck ; the teeth of
different animals; bones of the weasel; cats' claws; the
lower jaw of a squirrel; the trachea of some bird; one of
the vertebrae of an adder, etc. And where these measures
failed, the priests resorted to incantations, religious dances,
and the beating of drums or the rattling of dried gourds
filled with pebbles. Primitive races of men inhabiting the
most widely separated parts of the earth appear to have
adopted means almost identical with those just described
for driving away evil spirits. The holding of these super-
stitious beliefs is one of the most extraordinary character-
istics of the human race. It played an important part
throughout the classical period of Greek and Eoman
civilization, and also during the Middle Ages. Christianity
undoubtedly was a most potent agency in hastening the
eradication of the feeling, but even this great power has
not yet sufficed entirely to do away with superstition; for
traces of this weakness may still easily be detected in some
of the men and women with whom we daily come in contact.

CHAPTEK II
ORIENTAL MEDICINE

The researches of the scholar working in combination
with the engineer have unearthed — ^more particularly in
Mesopotamia, in Egypt and in Greece — evidences of an
ancient medical science far advanced beyond that briefly
described in the preceding chapter. These evidences relate
to nations that flourished as far back as four thousand
years B. C. While they are very fragmentary and cover
historical events which are often separated from one
another by long periods of time, these data nevertheless
suffice to give one a fairly good idea of the then prevailing
state of medical knowledge. Both Pagel and Neuburger
adopt the plan of discussing these different nationalities
separately, and I shall follow their example.

Medicine in Mesopotamia. — As appears from the most
recent investigations the Sumerians were the first occu-
pants of the region lying between the Euphrates and the
Tigris rivers. It was from them that their Semitic con-
querors, the Babylonians and the Assyrians, received a
civilization which, already about 4000 B. C, had reached
a wonderful degree of development. The canalization of
the low-lying lands of that 'region, the organization of a
religious and civil government of a most efficient type, the
invention first of picture-writing and then of the cuneiform
characters, the cultivation of the arts and natural sciences
and especially of astronomy and mathematics to a high
degree of perfection, — these are among the things which
were accomplished by this very clever race of men. In
addition, however, to these useful activities the Babylo-
nians developed and cultivated diligently the science of
astrology — that is, the science of predicting human events

12 GROWTH OF MEDICINE

(such as the death of the king, the occurrence of the plague
or of war, etc.) from various telluric and cosmic phe-
nomena— an eclipse of the sun, peculiarities of the
weather, the condition of vegetation, etc. The deeply-
rooted love of the human race for the supernatural — a
characteristic to which I have already briefly referred —
facilitated the development of this harmful practice, and
kept it alive through many succeeding centuries. Walter
Scott, in his romance entitled Quentin Durward, gives an
admirable portrait of a typical astrologer whom Louis XI.
of France maintained at his court during a part of the
seventeenth century.

While in other parts of the Orient the science of medi-
cine, as already stated at the beginning of this chapter,
made a noteworthy advance beyond the conditions observed
among the primitive races, in Mesopotamia this science,
which was far more important to the welfare of its inhabi-
tants than all the other branches of knowledge combined,
received very little attention and consequently made only
insignificant advances. The British Museum has in its
possession several thousand tablets which were dug up
from the ruins of Nineveh and which represent a part of
the library of the Assyrian King, Assurbanipal (668-626
B. C). Translations of the text of only a very few of
these tablets have thus far been published, and from these,
which embody the greater part of our knowledge of
Assyrian medicine, it appears that, for the present at least,
the estimate recorded above must stand. A few new facts,
however, have been brought to light, and they appear to
be of sufficient importance to merit brief consideration here.

In the first place, Herodotus, who visited Babylon about
300 B. C, has this to say in relation to the state of medicine
in that city: —

The following custom seems to me the wisest of their institutions
next to the one lately praised. They have no physicians, but, when
a man is ill, they lay him in the public square, and the passers-by
come up to him, and if they have ever had his disease themselves
or have known any one who has suffered from it, they give him
advice, recommending him to do whatever they found good in their

ORIENTAL MEDICINE 13

own case, or in the case known to them; and no one is allowed to
pass the sick man in silence without asking him what his ailment is.^

The Babylonians held some rather strange beliefs
regarding the construction of the human body and the
manner in which its functions are performed. The living
being, as they maintained, is composed of soul and body.
The intellect has its seat in the heart, the liver serving as
the central organ for the blood, which they considered to
be the true life principle. They divided this fluid into two
kinds — blood of the daytime (bright arterial) and that of
the night (dark venous). Although the blood was held
by them to be the basis of life, they evidently attached a
certain value to respiration, for one of their prayers begins
with these words : * * God, my creator, lead me by the hand ;
guide the breath of my mouth. ' * Disease was always looked
upon as something (usually personified as a demon) that
entered the body from without and that consequently had
to be expelled. There were special demons for the different
diseases. Thus, Asakku brought fever to the head, Namtar
threatened life with the plague, and Utukku attacked the
throat, Alu the breast, Gallu the hand, Rabisu the skin, and
so on. The most dreaded demons were the spirits of
the dead. Special amulets were employed as protective
remedies. Prayer formulae were also used. Here is one
among several that I find mentioned in Neuburger's
treatise : —

Wicked Consumption, villainous Consumption, Consumption
which never leaves a man, Consumption which cannot be driven
away, Consumption which cannot be induced to leave. Bad
Consumption, in the name of Heaven be placated, in the name of
Earth I conjure thee !

The genuine remedial agents employed in Babylonia
were of a most varied nature: a mixture of honey and
syrup of dates; medicinal herbs of different kinds for
internal administration; bloodletting; the use of cups for
drawing blood to the surface of the body ; warm baths and

1 Book I,, section 197, of Eawlinson's translation.

14 GROWTH OF MEDICINE

cold shower baths; rubbing oil over the body; medicated
clysters; the use of various salves; the use of secret
remedies which were composed of various ingredients and
which bore such names as *'the Sun God's remedy," **the
dog's tongue," "the skin of the yellow snake," ''the
medicine brought from the mountain of the human race,"
etc.

Some of the predictions made by the Babylonian astrolo-
gers are of sufficient interest to be placed on record. Here
are a few examples : —

If the west wind is blowing when the new moon is first seen,
there is hkely to be an unusual amount of illness during that
month.

If Venus approaches the constellation of Cancer, there will be
respect for law and prosperity in the land; those who are ill will
recover, and pregnant women will have easy confinements.

If Mercury makes its appearance on the fifteenth day of the
month, there will be corpses in the land. And again, if the con-
stellation of Cancer is obscured, a destructive demon will take
possession of the land, and there will be corpses.

If Jupiter and the other planets stand opposite one another,
some calamity will overtake the land. If Mars and Jupiter come
into conjunction, there will be deaths among the cattle.

If an eclipse of the Sun take place on the twenty-eighth day of
the month I jar, the king will have a long reign ; but, if it take place
on the twenty-ninth day of the month, there will be corpses on the
first day of the following month.

If there should be thunder during the month of Tisri, a spirit of
enmity will prevail in the land ; and if it should rain during that
month, both men and cattle will fall ill.

Besides these predictions, which were based upon phe-
nomena connected with the movements of the stars and the
conditions of the weather, there were others which the
people themselves were competent to make without the aid
of the professional astrologer or the official priest. Such,
for example, are the following ** omens": —

If a woman gives birth to a child the right ear of which is lacking,
long will be the reign of the prince of that land.

If a woman gives birth to a child both of whose ears are lacking,

ORIENTAL MEDICINE 15

sadness will come upon the land and it will lose some of its
importance.

If a woman gives birth to a child whose face resembles the beak
of a bird, there will surely be peace in the land.

If a woman gives birth to a child the right hand of which lacks
fingers, the sovereign of that country will be taken prisoner by his
enemies.

The keen interest taken by the priests in the matter of
predicting the outcome of various diseases led in due time
to their making records of the nature, symptoms and
progress of the latter. Although this practice was inaugu-
rated purely for the purpose of enabling them to foretell
with greater accuracy the probable issue of any given
malady, it nevertheless served also to establish on a firm
basis the custom of keeping records of the case-histories.
Only one thing more was now needed to render this
practice the first step in a genuine advance of medical
knowledge; but this step could not be made in Babylonia,
where priestcraft and superstition had struck such deep
roots in the public life. It was only in free Greece, and at
a time in its history when the spirit of Hippocrates exerted
an overpowering influence over the minds of men, that the
separation of the functions of the physician from those of
the priest became possible and was in due time effected.
(Neuburger.)

Before closing this very incomplete account of the state
of medical knowledge in Babylonia, it will be well to mention
some of the items of the law laid down by Hammurabi
(circa 2200 B. C.) for the guidance of the physicians of that
land with regard to the remuneration which they should
receive. At the same time I shall make no attempt to
reconcile the statement of Herodotus (given on page 12)
with the wording of this law, which distinctly recognizes
the existence of physicians in Mesopotamia. Possibly the
conditions in Nineveh in the fourth century B. C. were
different from what they had been eighteen centuries
earlier.

If a physician makes a deep cut with an operating knife of
bronze and effects a cure, or if with such a knife he opens a tumor

16 GROWTH OF MEDICINE

and thus avoids damaging the patient's eye, he shall receive as his
reward 10 shekels of silver. If the patient is an emancipated slave,
the fee shall be reduced to 5 shekels. In the case of a slave the
master to whom he belongs shall pay the physician 2 shekels.

If a physician makes a deep wound with an operating knife of
bronze and the patient dies, or if he opens a tumor with such a
knife and the patient 's eye is thereby destroyed, the operator shall
be punished by having his hands cut off.

If a physician, in operating upon the slave of a freedman, makes
a deep wound with an operating knife of bronze and thus kills the
patient, he shall give the owner a slave in exchange for the one
killed. And if, in opening a tumor with such a knife, the physician
destroys the slave's eye, he shall pay to the latter 's owner one-half
the slave 's value.

If a physician effects the healing of a broken bone or cures a
disease of the intestines, he shall receive from the patient a fee
of 5 shekels of silver.^

It would be difficult to imagine anything better adapted
to arrest the development of medical knowledge in a nation
than the promulgation of a law like that ascribed to
Hammurabi ; and one cannot be surprised at the statement
made by Herodotus, eighteen centuries later, ''that there
were no physicians in Babylon. ' ' Foolhardy, indeed, would
be the man who, for the sake of earning a possible reward
of six shekels of silver, would be willing to risk the danger
of having both his hands cut off; and yet every conscien-
tious and faithful practitioner of medicine in Babylon at
the time mentioned must necessarily have been obliged to
run this risk.

Medicine in Ancient Egypt. — Of the sources of informa-
tion with regard to the knowledge of medicine possessed
by the ancient Egyptians the most important are the
following: Homer's Odyssey; Herodotus; Diodorus;
Clemens of Alexandria; Pliny's Natural History; Dioscori-

2 From the statements just quoted it appears that a certain kind of bronze
(an alloy of copper and tin, with the addition perhaps of a little zinc) was
used in Assyria, in the manufacture of surgical knives, as early as during the
twenty-third century B. C. Dr. Meyer-Steineg, Professor of the History of
Medicine in the University of Jena, Germany, assures the writer that knives
made of this material are susceptible of being given as keen a cutting edge

ORIENTAL MEDICINE 17

des; the Papyrus Ebers; the Papyrus Brugsch; and the
Papyrus Birch, in the British Museum. Then, in addition
to these sources, there are the inscriptions found in recent
times on the walls of the temples and the pictures painted
on the wrappings of mummies, from both of which consid-
erable information with regard to various therapeutic
procedures and to the details of the process of embalming
Has been derived. Some of this information extends back
to about 3000 B. C. The healing art was at that time
entirely in the hands of the temple priests, who formed an
organized body with a sort of physician-in-chief at its head.
Two of these — Athotis and Tosorthos — attained such a high
standing and possessed such influence that they were chosen
Kings of Egypt. The practice of obstetrics was entrusted
to the care of women who had been trained to this work and
who acknowledged the authority of a skilled head-nurse of
their own sex. The patients who had received treatment
for their ailments at one or other of the temples presented
to these institutions gifts in the form of sculptured or
painted representations of the diseased or injured parts
of the body. In these and in other ways medicine and
pharmacy received contributions which were of no mean
value. Botanical gardens were established at various
places in Egypt and were cultivated with care. Chem-
istry— a name which derives its origin from a word in the
Egyptian language — also made considerable progress as a
science. On the other hand, the knowledge of the structure
and functions of the different parts of the human body
was very imperfect and remained unchanged for many
centuries. This would probably not have been the case if
the work of preparing the bodies for the process of
embalming had not been entrusted entirely to mere menials,
men who had no interest in anything but the mechanical
part of their occupation.

According to the statement of Clemens of Alexandria'

as are those made of the best of steel. At least one such bronze knife may be
seen in the collection of ancient surgical instruments, votive offerings, etc.,
which he is making for the benefit of the University.

8 A Christian ecclesiastical writer who lived about the year 200 A. D.

18 GROWTH OF MEDICINE

the Egyptian science of medicine is set forth in the last six
of the forty-two hermetic books, which were composed,
according to the prevailing belief, by the god Thot or
Thoiit (= Hermes of the Greeks). The first one of these
six books is devoted to the anatomy of the human body, the
second one to the diseases to which it is liable, the third to
surgery, the fourth to remedial agents, the fifth to the
diseases of the eye, and the sixth to diseases of women.
As to the remedial agents, Neuburger says that it has not
been found practicable to identify more than a very few of
the Egyptian drugs enumerated by Dioscorides. Homer,
who wrote at least five hundred years B. C, has something
to say on this subject in the Odyssey.* His words are as
follows : —

Such drugs Jove's daughter owned, with skill prepar'd,

And of prime virtue, by the wife of Thone,

Aegyptian Polydamna, given her.

For Aegypt teems with drugs, yielding no few

Which, mingled with the drink, are good, and many

Of baneful juice, and enemies to life.

There every man in skill medicinal

Excels; for they are sons of Pason^ all.

A physician of the present age, on reading the histories
of the ancient Egyptians, Greeks and other oriental
nations, finds it almost impossible to realize that many of
the characters designated as gods and goddesses, possibly
all of them, were not mythological persons, as they would
have been termed only a few years ago, but real human
beings like ourselves. Such, for example, was the opinion
of Cicero who, when asked why these people were spoken
of as gods, gave the following reply :^ *'It was a well-
established custom among the ancients to deify those who
had rendered to their fellow men important services, as

4 Lines 285-292 of Book IV. of the Earl of Derby's translation, first pub-
lished in 1864.

5 Pason is the same as Apollo, who was believed by the Greeks to have been
the inventor or discoverer of the art of medicine.

• See Le Clerc 's Histoire de la Medecine, Amsterdam, 1723.

ORIENTAL MEDICINE 19

Hercules, Castor and Pollux, Aesculapius, Bacchus and
many others had done.'* And I find that those modern
authors of the history of medicine whose works I have
consulted, are quite ready to accept even the gods called
by the Egyptians Osiris (or Serapis), Isis, and Thoiit
(or Hermes) as genuine historical personages. Such a
belief receives some degree of confirmation from the
following inscriptions which, according to the authority of
Le Clerc,^ were found engraved upon two columns dis-
covered in the city of Nyoa, in Arabia : —

(On the first column) : My father is Cronos, the youngest of
all the gods. I am King Osiris, who have visited with my armies
every country on the face of the earth — the remotest inhabitable
parts of India, the regions lying beneath the Bear, the neighbor-
hood of the sources of the Danube, and the shores of the Ocean.
I am the oldest son of Cronos, the scion of a fine and noble race.
I am related to the day. There is no part of the earth which I
have not visited, and I have filled the entire universe with my
benefits. (On the second column) : I am Isis, Queen of all this
country, and I have been taught by Thoiit. There is nobody who
has the power to loosen what I shall bind. I am the oldest daughter
of Cronos, the youngest of the gods. I am the wife and at the same
time the sister of King Osiris. To me is due the credit of having
been the first to teach men agriculture. I am the mother of King
Horus. I shine in the dog-star. It is I who built the city of
Bubastis. Farewell, Egypt, my native land.

The discovery of the art of medicine, says Le Clerc, was
attributed to Osiris and Isis, and they were also credited
with having taught it to Aesculapius.

At the cities of On (Heliopolis), Sais, Memphis and
Thebes were located the most celebrated of the Egyptian
temples, which were dedicated not merely to the worship
of their numerous gods, but also to the dissemination of
knowledge of various kinds and to the care of the sick and
maimed. In a word, they were — like the Aesculapian
temples at Trikka, Epidaurus and Cos, of which some
account will be given farther on — both hospitals for the

T At bottom of p. 15 of his Riatoire de la Midecine.

20 GROWTH OF MEDICINE

treatment of disease and schools for the training of
physicians. The chief priest of the temple bore also the
title of the *' physician-in-chief , " and exercised the pre-
rogatives of a chief magistrate. Under this system medical
knowledge advanced to a certain stage and then made no
further progress. The preponderance of the priestly {i.e.,
the superstitious) influence was too pronounced to permit
anything like real progress.

The papyrus Ebers makes mention of a number of dis-
eases, and among them the following may be noted : abdomi-
nal affections (probably dysentery), intestinal worms,
inflammations in the region of the anus, hemorrhoids,
painful disorders at the pit of the stomach, diseases of the
heart, pains in the head, urinary affections, dyspepsia,
swellings in the region of the neck, angina, a form of
disease of the liver, about thirty different affections of the
eyes, diseases of the hair, diseases of the skin, diseases of
women, diseases of children, affections of the nose, ears
and teeth, tumors, abscesses and ulcers.

In the matter of diagnosis the Egyptian physicians not
only employed inspection and palpation, but were in the
habit of examining the urine. A statement made in the
papyrus Ebers is good ground for the belief that they also
employed auscultation to some extent.

Therapeutics constituted beyond all question the strong-
est part of Egyptian medicine. As might be expected from
the strange mixture of the priest and the medical man in
every physician, the remedial measures commonly employed
consisted in part of prayers and incantations, and in part of
rational procedures and the use of drugs. Among the latter
class of remedies the following deserve to be mentioned:
emetics, cathartics and clysters. Bloodletting, sudorifics,
diuretics and substances which cause sneezing were also
often employed in Egypt. To produce vomiting the favorite
agents were the copper salts and oxymel of squills. Castor
oil disguised in beer was given as an aperient. Pome-
granate was the drug preferred for the expulsion of worms.
Mandragora and opium were also employed as remedies.
Foreign drugs were largely imported by the Phoenicians,

ORIENTAL MEDICINE 21

and in their successful campaigns against Asiatic nations
the Egyptians learned much about the use of these rarer
remedies. The different forms in which the Egyptians
administered their remedies included potions, electuaries,
gums to be chewed but not swallowed, gargles, snuffs,
inhalations, salves, plasters, poultices, injections, supposi-
tories, clysters and fumigations. The physicians, in their
practice, were subjected to very strict rules regarding the
amount of the doses to be given and the manner of admin-
istering the different remedies, and consequently they
received no encouragement to indulge in any individuality
of action. The prescriptions were written in very much
the same manner as are those of to-day; that is, they
contained the fundamental or important drugs, certain
accessory materials, and something which was intended
merely to correct the unpleasant taste of the mixture. In
comparison with those commonly written at a somewhat
later period these ancient prescriptions were of a very
simple character.

Up to the present time the researches of the archaeolo-
gists have thrown comparatively little light on the surgery
of the ancient Egyptians. The facts already ascertained,
however, are sufficient to warrant the statement that they
had reached a degree of knowledge and skill in this depart-
ment of medicine well in advance of that reached by any
of their contemporaries. They performed the operations
of circumcision and castration, and they removed tumors,
and their eye surgeons were especially renowned for the
work which they accomplished in their special department.
Their skill in manufacturing surgical instruments is amply
revealed in the specimens — instruments for cupping,
knives, hooks, forceps of different kinds, metal sounds and
probes, etc. — ^which have been dug up at the various sites
of ancient ruins. They must also have possessed consid-
erable manual skill, for without it they could not, in
embalming a corpse, have removed the entire brain from
the skull with a long hook, by way of the nasal passages,
and at the same time have left the form of the face
undisturbed.

22 GROWTH OF MEDICINE

From Joachim's German translation of the papyrus
Ebers,* as quoted by Neuburger, I copy the following
passages : —

If thou findest, in some part of the surface of a patient's body,
a tumor due to a collection of pus, and dost observe that at one
well-defined spot it rises up into a noticeable prominence, of
rounded form, thou should 'st say to thyself: This is a collection
of pus, which is forming among the tissues ; I will treat the disease

with the knife If thou findest, in the throat of a patient,

a small tumor containing pus, and dost observe that it presents
at one point a well-defined prominence like a wart, thou may'st
conclude that pus is collecting at this point. ..... If thou findest,

in a patient's throat, a fatty growth which resembles an abscess,
but which yields a peculiar sensation of softness under the pressure
of the finger, say to thyself: this man has a fatty tumor in his
throat ; I will treat the disease with the knife, but at the same time
I will be careful to avoid the blood-vessels.

These short extracts will suffice to show that the Egyptian
physicians of that early period — at least 1550 B. C. —
reasoned about pathological lesions in very much the same
manner as a physician of to-day would reason. In this
same ancient papyrus, however, foolish as well as sensible
statements appear. Thus, for example, mention is made
on the one hand of the fact that, in order to give a certain
remedy to an infant, it is sufficient to administer it to the
nurse who suckles the child (a proceeding which is not
uncommon in our own day) ; and then, in another part of
the text, it is stated that ^*if, on the day of its birth, the
infant does^ ^not cry, it will surely live ; but, if it says * ba, *
it will die. 'J

In matters relating to personal hygiene the ancient
Egyptians often displayed a remarkable degree of common
sense. They maintained, for example, that the majority
of diseases are due to the taking of food in excessive
quantity ; and, in harmony with this belief, they introduced
the custom of devoting three days out of every thirty to
the taking of emetics and clysters. Perhaps it was to this

8 Papyros Ebers, aus dem Aegyptischen zum ersten Male vollstandig uber-
setzt von H. Joachim, Berlin, 1890.

ORIENTAL MEDICINE 23

custom that they owed their good health, — a fact to which
both Herodotus and Diodorus testify. In principle this
practice agrees with that adopted by modern physicians,
who omit the emetics and substitute for the clysters the
drinking of certain mineral waters during a limited period
of the summer season and under the very agreeable
surroundings of a comfortable hotel at Carlsbad, Ems,
Wiesbaden or Saratoga. While the monthly plan of
purging the system of harmful elements must certainly
have been the more effective of the two, it cannot for a
moment be doubted that exceedingly few moderns would
be willing to subject themselves to such a regime.

In still other ways the ancient Egyptians displayed a
most intelligent respect for every measure that tended to
promote the general health of the community. They took
care, for example, to prevent the entrance of decomposing
materials into the soil and the ground water ; priests skilled
in work of this character made careful inspections of all
meats that were to be used for food ; stress was laid upon
the importance of keeping the dwelling houses clean; the
people were taught the value of bathing the body frequently,
of cultivating gynmastic exercises, of clothing themselves
suitably, and of employing the right sort of diet. At a still
later period of their history they adopted the custom of
drinking only water that had been either boiled or filtered.
A particular kind of beer, the gift of their first king, Osiris,
was the favorite beverage of the people. It was made from
barley and doubtless possessed intoxicating properties, as
is suggested by one of the papyrus texts in which the
following charge is brought against a student: **Thou
hast abandoned thy books and art devoting thyself to idle
pleasures, going from one beer-house to another. Thou
smellest so strongly of beer that men avoid thee."

A large proportion of the sources of information regard-
ing the medicine of the ancient Egyptians have been
brought to light during recent years, but so many gaps in
the series still remain unfilled that it is not possible to
furnish more than a disconnected and very imperfect
account. Archaeological investigations, however, are being

24 GROWTH OF MEDICINE

conducted with vigor and new discoveries are reported
almost every month. There are therefore good reasons for
hoping that, in the course of the next few years, much
additional light will be shed on the mode of life and
accomplishments of these pioneers of civilization, who,
before they passed out of history, succeeded in attaining
the highest degree of cultivation in the science and art of
medicine that had up to that time been attained by any
other nation. One thing is certain, says Neuburger, they
exerted a powerful influence upon the beginning of medicine
in Greece and upon the social hygiene of the Jewish people,
and therefore upon the human race at large.

CHAPTER III
ORIENTAL MEDICINE (Continued)

The Medicine of the Ancient Persians. — ^After Cyrus the
Great had put an end to Babylon as a power among the
nations the Persians became the leaders in all the affairs
not merely of Asia Minor but also of the entire country
from India to the shores of the Mediterranean; in fact,
they eventually also gained control of the land of the
Pharaohs. Notwithstanding the completeness of the
political power which they possessed over these conquered
races, they permitted them to retain their respective
religions and even their individual languages ; as evidence
of the correctness of which last statement the modern
discovery of inscriptions written in the three principal
tongues may be mentioned. The remarkable degree of
general culture which existed at Babylon at the time of the
Persian conquest, and which the Sumerians and Semites
had originally introduced, was left undisturbed by the
political change.

So far as we possess any knowledge regarding the
medicine of the ancient Persians, this information has been
derived, according to Neuburger, from the Zend-Avesta —
one of the ancient religious writings preserved by the
Parsees. It furnishes comparatively few facts of special
interest to physicians. In the main, the practice of medi-
cine must have differed very little from that employed
by the earliest Babylonian physicians, and briefly described
on pages 11-16. There are one or two additional
matters, however, which deserve to be mentioned here. It
was maintained, for example, that the touching of a corpse
produced a special contamination, a belief which interfered
most seriously with the study of anatomy, and therefore

26 GROWTH OF MEDICINE

prevented any real advance in medical knowledge. Then,
again, the ancient Persians appear to have taken compara-
tively little interest in surgery, for it is said that King
Darius I. was obliged, when he needed treatment for a
badly sprained ankle, to send for a Greek physician.
Finally, there may be found in Herodotus the following
statement, which shows that the Persians had learned
something of value, in practical hygiene, from their
neighbors, the Egyptians: —

The Great King (Cyrus), when he goes to the wars, is always
supplied with provisions carefully prepared at home, and with
cattle of his own. "Water, too, from the river Choaspes, which flows
by Susa, is taken with him for his drink, as that is the only water
which the kings of Persia taste. "Wherever he travels, he is
attended by a number of four-wheeled cars drawn by mules, in
which the Choaspes water, ready boiled for use, and stored in
flagons of silver, is moved with him from place to place.^

Neuburger makes the remark that the ancient Persians
are entitled to the gratitude of later generations for the
valuable service which they rendered the science of medi-
cine, inasmuch as, during the dynasty of the Sassanide
princes (fifth century A. D.) and at a time when European
culture was hastening to its destruction, they gave shelter
both to classical culture in general and to the medical
knowledge of the Greeks, and then afterward handed it
over to the conquering Arabs, who passed it on to our
forefathers.

The Medicine of the Old Testament. — There are no
medical writings which give any information concerning
the science and art of medicine as possessed by the ancient
Israelites, but the Bible contains a number of passages that
refer to matters which belong in the domain of medicine,
and more particularly in that of social hygiene. The mosaic
laws were framed with a view to the good of the Jewish
people as a whole, and were directed to such matters as
the prevention and suppression of epidemic diseases, the
combating venereal affections and prostitution, the care

1 Book I., p. 96, of George Eawlinson 's translation.

ORIENTAL MEDICINE 27

of the skin, the systematizing of work, the regulation of
sexual life, the intellectual cultivation of the race, the
provision of suitable clothing, dwellings and food, the use
of baths, etc. Many of these laws — like those, for example,
which prescribe rest on the Sabbath day, circumcision,
abstinence from eating the flesh of the pig, the isolation of
persons affected with leprosy, the observation of hygienic
rules in camp life, etc. — testify to a remarkably high degree
of the power to reason correctly; and, when considered in
the light of modern science, they seem to justify the pre-
diction made in Deuteronomy iv., 6. A similar prediction
(supposed to be spoken by God from Mount Sinai) is made
in Exodus xix., 6: ''And ye shall be unto me a kingdom
of priests, and an holy nation. ' ' That a large part of the
credit given to Moses for the wisdom displayed in these
sanitary laws really belongs to the Egyptians is shown by
the text of Acts vii., 22: ''And Moses was learned in all
the wisdom of the Egyptians, and was mighty in words and
in deeds."

As regards the manner in which the Israelites treated
the diseases which afflicted them the Bible furnishes ample
proof of the fact that they placed their chief reliance upon
prayers, sacrifices, and offerings at their temples, and
made comparatively small use of medicinal agents, dietetic
measures, and external applications. The favorable effect
of David 's harp-playing upon the melancholia of King Saul
furnishes the only instance, to be found in the Bible, of the
curative value of music in certain mental disorders.

The story of Naaman (2 Kings v.) deserves to be
mentioned briefly here. He was captain of the host of the
King of Syria (about 894 B. C.) and a man of valor, highly
esteemed by his master, but he was — according to the Bible
statement — a leper. Learning casually that there was in
Samaria a prophet who might be able to cure his disease,
he put a large sum of money into his sack and departed for
that country. "So Naaman came with his horses and with
his chariot, and stood at the door of the house of Elisha.
And Elisha sent a messenger unto him, saying. Go and
wash in Jordan seven times, and thy flesh shall come again

y~

28 GROWTH OF MEDICINE

to thee, and thou shalt be clean." Naaman, at first much
displeased with the advice given to him by Elisha, and
especially by the very informal manner in which it had
been communicated to him, finally decided to follow the
prophet's instructions. *^Then went he down, and dipped

himself seven times in Jordan, and his flesh came

again like unto the flesh of a little child, and he was clean.

And he returned to the man of God, and came, and

stood before him; and he said. Behold, now I know that
there is no God in all the earth, but in Israel: now there-
fore, I pray thee, take a blessing of thy servant." Elisha,
however, refused persistently to accept any reward for the
advice which he had given. He simply said to Naaman:
**Go in peace." Before he departed, however, Naaman
expressed to Elisha the hope that he would be pardoned
if he yielded to the necessity of bowing down to the god
Rimmon on certain occasions — as, for example, when he
accompanied his master, the king, on his visits to the
temple of that god for the purposes of worship. From the
evidence furnished by this account, as given in the Old
Testament, it is fair to assume that both Naaman and the
writer of the book of Kings believed that the cure had been
effected by supernatural means. The modern physician,
however, is not ready to accept such an interpretation of
the manner in which Naaman 's cure was effected, but
prefers to believe that the supposed leprosy was in reality
some curable form of skin disease which to the unprofes-
sional eye appeared like the other malady. It might, for
example, have been an aggravated general eczema, depend-
ent upon such excesses of eating and drinking as a wealthy
captain of the king's host would be likely to indulge in.
And if this supposition is correct, one cannot but admire
the great practical wisdom of Elisha in advising Naaman
to take seven baths — one a day presumably — in the river
Jordan, a spot so far removed from his home that it would
scarcely be possible for him to obtain any but the simplest
kind of diet during this comparatively long period of time.
An interesting case of snake-bite is briefly related in
Acts xxviii., 3-6. It is stated that ''when Paul (after being

ORIENTAL MEDICINE 29

shipwrecked on the Island of Melita) had gathered a bundle
of sticks, and laid them on the fire, there came a viper out
of the heat, and fastened on his hand. And when the
barbarians saw the venomous beast hang on his hand, they
said among themselves, No doubt this man is a murderer,
whom, though he hath escaped the sea, yet vengeance
suffereth not to live. And he shook off the beast into the
fire, and felt no harm. Howbeit they looked when he should
have swollen, or fallen down dead suddenly : but after they
had looked a great while, and saw no harm come to him,
they changed their minds, and said that he was a god.'*
This narrative is interesting in several respects, but there
is one feature that deserves to receive special mention, viz.,
the fact that Paul experienced no harm from the bite of a
poisonous serpent — a wound which frequently proves fatal.
Inasmuch as the account distinctly states that the reptile
** fastened on his hand" and that *Hhe barbarians saw the
venomous beast hang on his hand," the conclusion is war-
ranted that one or both of the creature 's fangs had entered
the hand by a curving route, and probably in such a manner
that the free end of each fang, from which the poison is
ejected, passed completely through the skin from within
outward. When the bite of a poisonous snake is of a
character such as I have just described, — and not a few
of them have this character, — only a very small quantity
of the venom is lodged in the subcutaneous tissues, where
the larger blood- and lymph-channels lie, and as a conse-
quence the person bitten escapes serious harm. On the
other hand, when the fangs enter the flesh in a less decidedly
curving direction, thus permitting a greater quantity of
the venom to reach and remain in the deep-lying tissues,
serious or even fatal results may be anticipated. The point,
then, which I desire to make is simply this: Paul's escape
from death in this instance may perfectly well be ascribed
to natural causes.

The Israelites, at a certain stage of their history, appear
to have completely divorced the practice of medicine from
the priestly function. In one place, for example, it is stated
that King Asa sought relief from his ailment, not from

30 GROWTH OF MEDICINE

Jehovah, but from the physicians. Jeremiah expresses
astonishment that not a single physician is to be found in
Gilead. May this not be interpreted as signifying that
regularly established physicians were at that time (595
B. C.) to be found in some parts of Palestine? And, at a
much earlier period (1500 B. C), Job calls his friends
''physicians of no value" (Job xiiL, iv.). From these and
a number of other statements in the Bible it seems per-
missible to believe that, at a very early period of history,
the Jewish physicians occupied an entirely independent
position.

It would doubtless appear strange to most readers of
this brief sketch of the history of medicine if some refer-
ence were not made in this place to Luke, the author of the
gospel which bears his name and of the Acts of the
Apostles, and who was also the companion of Paul on his
journey to Rome and during a portion of the latter 's stay
in that city. Luke was a native of Antioch, in Syria, and
not a Jew. He was a physician and tradition says that he
was also a painter. It is not known where he received his
medical training, but it is not at all unlikely that he studied
at Alexandria, in Egypt, where the greatest facilities for
such training, obtainable at that period, were to be found.
His style of writing shows plainly that he was a man of
considerable cultivation and endowed with a clear and
logical mind ; and if he had not possessed a genial person-
ality he would hardly have been known as "the beloved
physician"; nor could any other motive but those of loyal,
self-sacrificing friendship for his friend, and a desire to
promote the cause of Christianity, have led him to share
with Paul the dangers and discomforts of the journey to
Rome.

The Medicine of India, China and Japan. — It would be
too much of a departure from the plan which is being
followed in the writing of this history to attempt to
describe, even in the briefest manner, the mode of develop-
ment of the science and art of medicine in India, China
and Japan. Unquestionably the earlier physicians of
these countries made many valuable contributions to

ORIENTAL MEDICINE 31

medical knowledge, but they were made at such a period
of time, or under such conditions, that they could not have
exerted an appreciable influence upon the development of
medicine in ancient Greece, — certainly no such influence as
was exerted by Assyria and Persia, and especially by
Egypt. It therefore seems permissible to speak of the
medicine of these more remote countries only incidentally,
and not as an integral part of the series of centres of
learning which made the medicine of ancient Greece the
direct ancestor — if I may use such a term — of European
medicine.^ In conformity with this idea it will be well to
mention here briefly a few of the more important facts
relating to the achievements of the physicians of the three
countries named.

The most celebrated medical authors in India were
Caraka, Siisruta and Vagbhata — *'The ancient trinity,"
as they were called. Caraka probably lived during the
early part of the Christian era, Susruta during the fifth
century, and Vagbhata not later than during the seventh
century A. D. It is apparent, therefore, that none of the
treatises written by these authors could have exerted the
slightest influence upon the growth of medical knowledge
in ancient Greece.

The crudeness of many of the conceptions held by these
Hindu physicians concerning pathology is revealed in the
following definition : ' ' Health is the expression of the
normal composition of the three elementary substances
(air, mucus and bile) which play a vital part in the
machinery of the human body, and it is also dependent
upon the existence of normal quantitative relations between
these three substances; and when the latter are damaged,
or when they are abnormally increased or diminished, then
disease of one kind or another makes its appearance.'"

2 Neuburger speaks of the growth of medical knowledge in India as a
development that ran parallel with that of ancient Greece.

3 From Neuburger. — Equally crude are their ideas respecting the causes of
disease, as shown by the following items selected from quite a long list of
etiological factors: errors in diet and in the habits of life, climatic influences,
psychic factors, heredity, poison, supernatural influences like the anger of the

32 GROWTH OF MEDICINE

Great stress was laid by the physicians as well as by the
priests of ancient India upon the observance of very
elaborate rules respecting the care of the person while in
health and, very naturally, when a patient became ill the
physician in charge paid quite as much attention to the
employment of hygienic and dietetic measures in effecting
the desired cure as to the administering of drugs.

The list of the commonly employed hygienic measures is
too long for reproduction in its entirety in this brief sketch,
but an enumeration of some of the more important items
may prove interesting. In estimating the value of these
rules the reader should bear in mind that they were
intended for people living in a hot climate. Daily bathing
heads the list. Then follow: regulation of the bowels;
rubbing the teeth with fresh twigs of certain trees which
possess astringent properties, and also brushing them twice
a day ; rinsing the mouth with appropriate washes ; rubbing
the eyes mth salves; anointing the body with perfumed
oils; cutting the nails every five days, etc. Two meals a
day were prescribed — the first one between nine in the
morning and noon, and the second between seven and ten
in the evening. * ' Only a moderate amount of water should
be drunk during the meal ; drinking water at the beginning
of a meal delays digestion, while a copious draught at the
end produces obesity. After the meal the mouth should be
carefully cleansed and a short walk should be taken."
Among the more important articles of food the following
deserve to be mentioned: rice, ripe fruit, the ordinary

gods, the evil powers of demons, etc. For purposes of diagnosis the earlier
Indian physicians utilized not only inspection, palpation and auscultation, but
also the senses of taste and smell. They noted the losses and increases in the
weight of the body, changes in the appearance of the skin, the tongue and the
excretions, alterations in the configuration of the body, the form and other
characteristics of swellings, etc. They also noted changes in the patient's
voice, in the character of the breathing, in the noises accompanying movements
of the joints and the twistings of the intestines. The crepitus caused by the
rubbing together of the roughened ends of a fractured bone did not escape
their notice. At a later period, doubtless through the influence of the teachings
of foreign physicians, they attached great importance to the examination
of the pulse.

ORIENTAL MEDICINE 33

vegetables, ginger, garlic, salt, milk, oil, melted butter,
honey and sugar cane. If meat is eaten, preference should
be given to venison, wild fowl and the flesh of the buffalo.
The meat of the pig, and beef, as well as fish, are less
conducive to health. Gymnastic exercises in moderation
are beneficial. Sleep should be indulged in during the day
only after some specially severe exercise ; at night it should
not be extended beyond one hour before sunrise. Bathing
immediately after eating is harmful, and it is not to be
indulged in when one is affected with a cold, with a high
fever, with diarrhoea, or with some disease of the eyes
or ears. A hot bath or washing with warm water may be
beneficial for the lower half of the body, but for the upper
half it is harmful. Sea bathing and cold baths (preferably
in the river Ganges) are beneficial. The clothing worn
should be clean ; soiled garments are likely to produce skin
diseases. It is advisable to wear shoes, and an umbrella
or a staff should be carried. The wearing of garlands,
finery, and jewels increases the vital powers and keeps
away evil spirits. The following are good measures to
adopt for the preservation of health: an emetic once a
week; a laxative once a month; and a bloodletting twice
a year. All the measures enumerated above were subject
to modification according to changes in the season, the
locality, the weather, and various other circumstances.

In harmony with the extraordinary fruitfulness of the
land the pharmacopoeia of India is very rich. It is a
remarkable fact that not one of the nupaerous drugs
mentioned in the official list is of European origin. The
great majority of them belong to the vegetable kingdom;
Caraka stating that he knew of 500 plants that possessed
remedial virtues, while Siisruta placed the number at 760.
Then, too, the list contains a goodly number of drugs which
belong, some to the animal and others to the mineral king-
dom. It appears that the physicians of India began using
mineral substances, both externally and internally, at a
very early period of their history. Among such substances
the following may be mentioned: sulphate of copper,
sulphate of iron, sulphate of lead, oxide of lead, sulphur.

34 GROWTH OF MEDICINE

arsenic, borax, alum, potash, chloride of ammonium, gold,
precious stones of different kinds, etc. The people of India
were skilled in chemical and pharmaceutical work. The
drugs were prepared by them in a great variety of ways —
as, for instance, extracts of the juices of plants, infusions,
decoctions, electuaries, mixtures, syrups, pills, pastes,
powders, suppositories, collyria, salves, etc. Practicing
physicians carried with them a sort of portable medicine
chest, and they often collected, themselves, the medicinal
plants which they required. Susruta gives instructions as
to the spots where certain plants are most likely to be
found, and as to the seasons when they should be gathered.
Charlatanry and mysticism often played a part in this
business. Thus, it was maintained that drugs collected and
prepared by persons other than physicians did not produce
the desired effects. The fact that cosmetics (especially
hair dyes), ''elixirs of life," aphrodisiacs, poisons and
antidotes for poisons, occupy the most prominent place in
the list of pharmaceutic preparations sold, casts a glaring
ray of light, as Neuburger states, on the degree of culture
among the people of ancient India.

The list of separate maladies recognized by the physi-
cians of the latter country is inordinately long. There
were 26 kinds of fevers, 13 species of swellings of the lower
abdomen, 20 different diseases due to worms, 20 kinds of
urinary diseases, 8 varieties of strangury, 5 kinds of
jaundice, 5 varieties of cough or asthma, 18 kinds of
''leprosy," 6 kinds of abscesses, 76 different eye diseases,
28 affections of the ear, 65 disorders of the mouth, 31 nasal
affections, 18 diseases of the throat, a large number of
mental disorders, etc. It seems scarcely necessary to
remark that these so-called diseases were in reality only
groups of certain types of loosely related symptoms. The
term "leprosy," for example, included, besides the disease
which modern physicians call by that name, a number of
different affections of the skin. It is worth noting here
that diabetes mellitus, which is one of the twenty different
kinds of urinary diseases enumerated in the classified list
mentioned above, was first described by the physicians of

ORIENTAL MEDICINE 35

India, whose attention was directed to the disorder by
observing that flies and other insects were attracted to the
urine of these patients by reason of its sweetness. It is
also an interesting fact that occasionally these physicians,
who, beyond a doubt, were keen observers of symptoms,
paid some attention to the anatomical features of the
individual cases. Thus, it is stated that the particular
form of swelling of the lower abdomen, to which they
applied the name ''splenic belly," is dependent upon *'an
enlarged spleen which distends the left side, is as hard as
a stone, and is arched like the back of a turtle"; whereas
they spoke of *'an enlargement of the liver" when very
much the same conditions were observed on the right side
of the abdomen. The accuracy of their clinical observations
is particularly noticeable in their accounts of cases of
consumption, apoplexy, epilepsy, hemicrariia, tetanus,
rheumatism, venereal diseases, some affections of the skin,
and insanity. It was in their surgical technique, however,
that the physicians of ancient India were distinguished
above all their brethren of the neighboring oriental
countries, and this superiority they maintained for a very
long time. Among the operations which they performed
the following may be mentioned : they removed tumors by
excising them, they opened abscesses by the use of the
knife, they employed scarifications (in inflanmiations of
the throat) and made punctures (in hydrocele and ascites),
they passed probes into fistulae, they extracted foreign
bodies, and they employed needles armed with hairs taken
from the horse's tail or with thread composed of flax or
hemp. According to Susruta their stock of instruments
was composed of 101 blunt and 20 cutting instruments.
Among those which were blunt there were forceps of
different sizes and forms, hooks, tubes, probes or sounds,
catheters, bougies, etc. They made use of the magnet for
drawing out foreign bodies of iron, and they applied cups
for therapeutic purposes. Their cutting instruments con-
sisted of knives, bistouris, lancets, scissors, trochars,
needles, etc. Steel was the metal of which they were made ;
for the people of India learned at a very early period how

36 GROWTH OF MEDICINE

to make steel. In suitable cases cauterization, either with
the actual cautery or with caustic potash, was a favorite
method of treatment with the surgeons of ancient India.
"Burning with the heated iron," they taught, ''is more
effective than cauterization with potash, inasmuch as it
permanently cures diseases which may not be cured by
either drugs, surgical instruments, or chemical cauterizing
agents." In cases of enlargement of the spleen they
plunged red-hot needles into the parenchyma of the organ,
presumably through the skin and other overlying tissues.
There were fourteen different kinds of surgical dressings ;
cotton, woolen, linen and silk being the materials used for
bandages, and strips of bamboo or some other wood for
splints. When the conditions permitted such a proceeding,
it was customary to sew up wounds of the head, face and
windpipe. Furthermore, it was the rule to perform all
surgical operations at a time when the constellations were
favorable. Religious ceremonies were performed both
before the operation and after it was completed, and it was
also considered necessary that the operator should face
the west and the patient the east. Intoxication was
employed as a means of securing narcosis. Owing to their
scrupulous cleanliness and the minute attention which they
paid to details, the surgeons of ancient India obtained for
a long time a much higher degree of success than did the
surgeons of other oriental nations. At the same time they
were not lacking in that degree of boldness which enables
an operator — in critical cases which probably without such
prompt and radical action would terminate fatally — to save
life. For example, they did not hesitate to open the
abdominal cavity and to sew up a wound in the intestines ;
they cut for stone in the bladder, employing for this purpose
the lateral method of operating; and they performed a
great variety of plastic operations.

Some of their hygienic rules concerning pregnant and
nursing women are eminently practical; others would
hardly be approved by modern accoucheurs. Here are a
few of these rules: During the period of a woman's
pregnancy close attention should be paid to her diet, and

ORIENTAL MEDICINE 37

special care should be exercised by her to avoid excesses
or errors of any kind. When the ninth month is reached
she should take up her abode in the small cottage in which
she is eventually to be confined — a building erected with
special religious ceremonies and thoroughly fitted with
everything that is likely to conduce to her comfort. At the
time of the actual confinement she should have with her
four female assistants, and all those measures, of either a
religious or a practical character, which have in view the
hastening of the birth of the infant, should be scrupulously
carried out. If any delay in the delivery of the after-birth
occurs, the removal of the mass may be promoted by the
employment of well-directed pressure over the lower part
of the abdomen, by shaking the body, and also, if necessary,
by giving an emetic. The woman in childbed should not be
allowed to get up before the tenth day after her confine-
ment, and for a period of six weeks her diet should be most
carefully watched. On the third day the child should be
put to the mother's breast; up to that time it should be
given only honey and butter. If the mother, for any
reason, is not able to suckle the infant, a wet-nurse should
be employed for the purpose, but not until the physician
shall have subjected her to a most thorough examination
and shall have instructed her minutely in regard to her
own diet. The subsequent care of the child was provided
for in the most particular manner : It was restricted to a
carefully planned diet; it was not allowed to sit or to lie
except in certain prescribed positions ; its times for sleep-
ing were strictly ordered ; it was permitted to amuse itself
only in certain ways; — in brief, everything was done
according to strict rules, even special precautions being
taken to guard the child, during the first years of life,
against dangerous demons. Weaning began after the
sixth month, and for a certain length of time the child was
fed largely on rice. In cases of difficult labor and in their
gynaecological practice the physicians of ancient India did
not manifest any special knowledge or skill.

One of the instructions given to young physicians in
India when they were about to enter upon the practice of

38 GROWTH OF MEDICINE

their profession, may be of interest to the reader. It is
worded as follows: ''Let thy hair and finger nails be cut
short, keep thy body clean, put on white garments, wear
shoes on thy feet, and carry a staff or umbrella in thy hand.
Thy demeanor should be humble, and thy heart pure and
free from deceitf ulness. ' ' The following proverb, although
it originated in India, is well worthy of acceptance in every
part of the world: ''When you are ill the physician will
be to you a father; when you have recovered from your
illness you will find him a friend; and when your health
is fully re-established he will act as your protector."

On a previous page the statement has been made that
the science and art of medicine developed in ancient Greece
quite independently of any influence that might have been
exerted by the teachings of the physicians of India. This
statement should be somewhat modified, for it is reasonable
to suppose, although directly confirmatory evidence has
not yet been discovered, that, through the channels of trade
between the two countries, some knowledge of the doings
of the physicians of India must have reached the ears of
their Greek brethren. On the other hand, at a later period
of history (after Alexander the Great had invaded India),
the relations between the two countries became quite close
and were kept up without a break for several hundred
years. During the earlier part of this later period, as
appears from the writings of Hippocrates, Dioscorides and
Galen, various drugs and methods of treatment employed
by the physicians of India were adopted by the practitioners
of Greece.

Medicine of the Chinese and Japanese. — The isolation
of China with respect to those countries which were within
comparatively easy reach and in which there was a civiliza-
tion that, already several thousand years before the
Christian era, had attained a remarkable degree of
development (India, Babylonia and Egypt, for example) ;
her blind belief in authority ; her unwillingness to tolerate
any influences that seemed to emanate from foreigners;
and her complete satisfaction with her own methods of
doing things, with her own beliefs, and with her own

ORIENTAL MEDICINE 39

natural and manufactured products, — these, it is generally
believed, were the most important factors in keeping this
remarkable nation in a state of immobility as regards at
least some departments of human knowledge and accom-
plishment. This is particularly true in respect of the
science and art of medicine. But China is at last waking
up from this lethargic state. A wonderful change has come
over her during the past twenty or thirty years, and she
is now beginning to realize that, with her millions of
population and wonderful natural resources, she has an
important part to play in advancing the civilization of the
world.

The preceding remarks must not be interpreted as
signifying that, during the long ages of the past, China has
not been developing and is not able at the present time to
show a record of very creditable work accomplished in
many departments of human activity. In her early history,
many centuries ago, she accomplished great things, and
all — so far as we now know — ^without aid from neighboring
nations; but there came a time when all this creative
activity ceased, and then, for long periods of years, she
appeared to rest satisfied with the advances which she had
already made, and to have no further ambition to add to
the stock of her possessions.

Among the valuable things which should be credited to
the Chinese are the following: the discovery of the compass
(about 1100 B. C), the making of porcelain, the invention
of printing, the raising of silkworms, the manufacture of
glass and of paper, the successful dyeing with purple,
embroidering with gold, working in metals, the artistic
cutting of precious stones, enameling, the making of * ' India
ink," etc. Furthermore, it is a fact most creditable to the
Chinese that in no other country in the world have scholars
been held in such high esteem, or assigned so high a rank,
as they have been and still are in China.

Chinese medicine possesses a very rich literature. The
first medical treatise, which deals with plants that possess
medicinal virtues, is ascribed to the Emperor Schin-Nung,
who flourished about 2800 B. C. This is the monarch who

40 GROWTH OF MEDICINE

taught his people from which springs they should drink,
and who tested all the plants of his vast empire with
reference to their healing properties. According to the
legend the wall of his stomach was so thin that he could
look through it and see everything that was going on in the
interior of that organ. In this way he was able to carry
on a large series of experiments upon himself in regard
to the action of different poisons and their antidotes. It
is also related that medical knowledge was still further
advanced by the yellow Emperor Hoang-Ti who lived about
2650 B. C, and who is credited by the Chinese with having
invented arithmetic and music. The treatise called ''Noi-
King," which deals with the subject of internal diseases
and gives a systematic account of human anatomy, is also
credited by the Chinese to this monarch; but Neuburger
maintains that this book, which is still in common use in
China, is of much more recent origin. There are several
other medical treatises which deserve to be mentioned.
Such, for example, are the following: the celebrated book
on the pulse, written by Wang-Schu-Scho in the third
century B. C. ; two very important books written by Cho-
Chiyu-Kei — one bearing the title ''Schang-Han-Lun" (On
Fevers) and the other that of ''Kin-Kwei" (Golden
Casket) ; — the different treatises written by Tschang-Ki
(tenth century A. D.) and published in the collection called
**The Golden Mirror of the Forefathers in Medicine" (I-
Tsung-Kin-Kien") ; and, finally, the very popular modern
work (in forty volumes) entitled ^'The Trustworthy Guide
in the Science and Art of Medicine" ('*Ching-Che-Chun-
Ching"). Of these forty volumes, seven are devoted to
nosology, eight to pharmacy, five to pathology, six to
surgery, and the remainder to children's and women's
diseases.

Anatomy, it appears, has never played other than a very
insignificant part in the Chinese system of medicine. This
is not to be wondered at when we remember that their
religion makes the dissection of a human body a sin worthy
of punishment. No mutilated person, the Chinese believed,
would be permitted, upon reaching the domain of the dead,

ORIENTAL MEDICINE 41

to rejoin Ms ancestors. About the year 1700 A. D. the
Emperor Kang-Hi made the attempt to incorporate
anatomy as a part of the regular study of medicine in
the Chinese Empire ; his first step being the authorization
of P. Perennin, a Jesuit Father, to translate Dionis' work
on anatomy into the Chinese. His efforts were, however,
unsuccessful, owing to the strong opposition offered by the
native physicians. And the attempts made during more
recent times to accomplish the desired reform by intro-
ducing copies of European anatomical illustrations do not
appear, as yet, to have produced any appreciable impres-
sion. In very recent years, however, the medical mission-
aries, sent out, if I am rightly informed, from the United
States, are giving excellent instruction in anatomy.

Physiology, as taught by the Chinese, is something
beyond the comprehension of modern Europeans. Neu-
burger explains their views in the following manner:
''The cosmos is the product of the combined action of two
dissimilar forces — the male (Yang) and the female (Yin).
When these forces work in harmony a state of equilibrium

results Matter consists of five elements, viz.,

wood, fire, earth, metal, and water; and all things are
composed of these elements. In sympathetic relationship
with these five elements stand the five planets (Jupiter,
Mars, Saturn, Venus, Mercury), the five different kinds of
air (wind, heat, moisture, dryness, cold), the five quarters
of the globe (east, south, west, north and the equator),
the five periods of the year (in addition to the four which
we recognize, the Chinese make a fifth period out of the
last eighteen days of spring, summer, autumn and winter),
the five times of day, the five colors (green or blue, red,

yellow, white and black), the five musical tones, etc

As in the cosmos, so in man the two primeval forces —
Yang and Yin — underlie all his vital processes. Thus, his
body is made up of the five elements of which all matter is
composed, and health depends upon the maintenance of
a state of equilibrium between the male and the female
forces, etc." After this brief exposition it seems unneces-

42 GROWTH OF MEDICINE

sary to devote any further space to the consideration of
the physiological doctrines of the Chinese.

With respect to the questions of diagnosis and prognosis
it may be stated that the Chinese attach great importance
to the necessity of making a most careful objective exami-
nation of the entire body; but, when one investigates the
precise manner in which this examination is to be carried
out, it soon appears that most of the details relate to
matters of a purely fanciful or mystical nature. The only
steps of real importance, according to them, are the exami-
nation of the patient's pulse and the inspection of his
eyesight and his tongue. From the examination of the
pulse alone they believe it possible to diagnose the nature
and seat of the disease. To examine the pulse properly is
a complicated affair and can scarcely be carried out in
actual practice in less time than ten minutes; indeed, in
certain cases the physician may find it necessary to devote
two or three hours to the business. According to the
Chinese scheme there are many different kinds of pulse,
and there are no less than thirty-seven different types of
condition presented by the tongue, each bearing its own
special pathological significance.

Disease, so reads the Chinese doctrine, is a discord, a
disturbance of equilibrium, caused by the preponderance
of one or the other of the primeval forces (the male or the
female). It manifests itself in some disorder of the
circulation of the vital air and the blood, and eventually
involves the organs of the body. Wind, cold, dryness,
moisture, the emotions and passions, poisons, and also evil
spirits and imaginary beasts are the causes of disease.

No other nation, says Neuburger, has at its command
such a large number of remedial drugs; and it is also a
fact, he adds, that the department of therapeutics is that
in which Chinese medicine has reached its highest develop-
ment. The steadfast belief that in nature there exists a
remedy for every human ill led the physicians of that
country to search diligently in all possible directions for
vegetable and animal and also, to some extent, mineral
substances which might possess remedial virtues. Although

ORIENTAL MEDICINE 43

this search necessarily brought to notice a lot of useless
drugs, it cannot be denied that eventually it added a
considerable number of remedies which have proved useful
to the medical profession of the entire world. In this
category belong the following: rhubarb, pomegranate root
as a cure for worms, camphor, aconite, cannabis, iron (for
the relief of anaemia), arsenic (for malarial and skin
diseases), sulphur and mercury (both of these for affections
of the skin), sodium sulphate, copper sulphate (as an
emetic), alum, sal ammoniac and musk (for nervous
affections). Toward the middle of the sixteenth century
A. D. there was published, under the title ''Pen-Tsao-
Kang-Mu," a monumental work (fifty-two volumes) in
which are very fully described no fewer than 1800 remedies,
mostly of a vegetable nature. Prophylactic Inoculation
with the pus from a smallpox pustule was practised by the
Chinese as long ago as during the eleventh century A. D.,
''thus constituting a forerunner of our modern serum
therapy." (Neuburger.) Vaccination was not introduced
into China until during the nineteenth century of the
present era. It is a curious fact that, in the choice of a
remedy, the Chinese physicians attach a certain degree of
importance to the form and color of the drug, as symbols
indicative of the effect which they may be expected to
produce. Thus, the red blossoms of the hibiscus plant are
believed to be more efiicacious than the white as an
emmenagogue; saffron, being of a yellow color, possesses
the power to relieve jaundice; beans that have the shape
of a kidney should be prescribed in cases of renal disease ;
glow-worms should form a part of all eye-washes, etc.

The doses prescribed are very large, and the medicines
are often put up in an attractive form, with labels on which
such descriptive titles as these are written: ''Powders of
the Three very wise Men," or "Powders recommended by
Five Distinguished Physicians" — titles which are calcu-
lated to work upon the imagination of the patient.

There are two methods of treatment which the Chinese
physicians are very fond of employing for the relief of a
great variety of diseases — viz., acupuncture and cauteriza-

44 GROWTH OF MEDICINE

tion of the skin over the seat of the malady by means of
what are termed *'moxae" — moxibustion. Moxae are pre-
pared by kneading together into a cone-shaped, tinder-like
mass the leaves of the artemisia vulgaris, then drying it
thoroughly. Such a mass is attached to the skin at the
affected spot by simply moistening the base of the cone,
after which the apex is ignited. Some physicians prefer
to interpose a thin sheet of metal between the skin and the
base of the moxa. The manner in which these contrivances
should be used in the different diseases and the proper
number to employ are matters subject to fixed rules. In
a strong individual, for example, as many as fifty moxae
may be used at a time. In affections of the chest they were
applied to the patient's back, in diseases of the stomach
to the shoulders, and in venereal affections over the spinal
column. In acupuncture, which is a procedure invented
by the Chinese, slender needles of gold, silver or highly
tempered steel, from 5 to 22 centimetres (2 in.-8% in.) in
length, were forced through the stretched skin to different
depths (1% in.-134 in.) and then driven farther inward in
a rotary direction by means of a small hammer. The
needles, after being allowed to remain in situ for a few
minutes, were withdrawn, and pressure was made with
the hand over the small wounds, or a moxa was burned
over the spot. There are in all 388 places where acu-
puncture may be performed, and a chart of the body,
showing where these places are located, has been prepared
for the guidance of the Chinese physicians. Neuburger
calls attention to the fact that the latter dislike the sight
of blood, and that this is one of the reasons why acupunc-
ture and the use of moxae have grown to be such popular
remedies. Bloodletting is rarely employed by them; but
dry cupping, on the contrary, is a favorite procedure in
certain maladies. Massage is generally performed by old
or blind women, and much attention is devoted to the
''movement cure," which is said to have been invented
about 2500 B. C.

As may readily be imagined, the Chinese — owing to
their dislike for the sight of blood and also by reason of

ORIENTAL MEDICINE 45

their ignorance of anatomy — ^have not advanced, in sur-
gery, beyond the most primitive state of that art.

The science of public health is quite unknown in China.
In a Chinese treatise entitled ''Long Life," the following
advice is given: ''Always rise early in the morning, take
some breakfast before you leave your residence, drink a
little tea before eating, at the mid-day meal partake of
well-cooked but not too highly salted food, eat slowly, take
a nap of two hours after the meal, eat lightly at night, and,
before going to bed, rinse your mouth with tea and
have the soles of your feet rubbed until they are warm."
(Neuburger.)

Up to the latter part of the nineteenth century of the
present era, Japan, so far as medical matters are con-
cerned, differed in no material respect from China. During
the last fifty or sixty years, however, — that is, since the
visit of Commodore Perry, of the United States Navy, to
that country, — wonderful changes have taken place; and
now Japan, as a result of her determination to adopt the
methods of education, of utilizing steam and electric power,
etc., has already taken a leading place in the council of
nations. The physicians, many of whom received their
training in the best schools of Europe and the United
States, are contributing to-day their full share toward
advancing the science of medicine. That China is fol-
lowing in the footsteps of Japan is already plainly evident,
and no intelligent observer entertains the slightest doubt
of her ultimately — probably at no distant day — possessing
a corps of medical men as well educated, as efficient in the
treatment of disease, and as practical in public hygiene as
their European and American confreres. During thou-
sands of years China has suffered severely from the
blighting tyranny of superstition, priestcraft and selfish
bureaucracy, and, now that the sunlight of truth and
genuine liberty is beginning to search every nook and
cranny of that great country, we who have had the advan-
tage of this beneficent influence for so many scores of years
truly rejoice over the change that is taking place in China.

CHAPTER IV

GREEK MEDICINE AT THE DAWN OF HISTORY

It is from Greece and from Greece alone, says Darem-
berg, that our modern medicine derives its origin.

It has come down to us, in a direct line, through the sheer force
of its inherent excellence, and with little or no aid from outside
sources. Harvey, Bichat and Broussais are as much the legitimate
heirs of Hippocrates, Herophilus, Galen, Berenger de Carpi and
Vesalius, as Hippocrates is the heir of Homer, and as this divine
singer of the anger of Achilles is himself the product of a civiliza-
tion that existed before his day and that was in all probability the
creation of Hindu influences.

It is to the development of medical knowledge in Greece,
therefore, that our attention should next be directed, and
more particularly to that period which belongs to the dawn
of history — the pre-Homeric period.

The pre-Homeric Period of Medicine in Greece. — The
poems of Homer, the Iliad and the Odyssey, furnish us
with the earliest and almost the only written evidence of
the state of medicine in Greece during that period of time.
They were probably written, according to the authority
of the Earl of Derby, somewhere about 800 B. C, and
modern investigations show that the siege of Troy, the
theme of the Iliad, occurred between the years 1194 and
1184 B. C. These investigations also show that in this
region, and especially in the Island of Crete and in Mycenae
on the neighboring mainland of Asia Minor, at this time
and probably several hundred years earlier, there existed
a high degree of civilization. Specimens of a written
language, for example, were found among the objects
recovered from the ruins of the palace of King Minos at

GREEK MEDICINE 47

Cnossus in Crete, but hitherto no interpreter of this
unknown language has been found. It is reasonable to
expect, however, that in due time these Minoan records
will be translated, that still other records belonging to this
remote age will be discovered, and that much valuable
information regarding the condition of medical knowledge
in Greece during this long period will then be revealed to
us. Strange as it may appear, the classical Greek writers
seem to have possessed very little knowledge concerning
this highly developed civilization at Cnossus. And yet, if
we stop to consider the matter, their silence will appear
less strange for the following reasons. Some great
calamity (war, an earthquake, or a conflagration) must
have destroyed many of the evidences of Minoan civiliza-
tion besides those which are now being brought to light;
then, also, several hundred years elapsed between the
occurrence of this disaster and the classical period of
Greek culture ; and, finally, there is the fact that the knowl-
edge of past historical events, when kept alive simply by
tradition, slowly vanishes, until finally it becomes so vague
as to possess very little value. The discoveries made in
the Island of Crete and at Mycenae were not known to
Daremberg when he wrote the lines quoted above, but he
felt perfectly sure, from his knowledge of the laws of
development in general, that a product so highly cultured
as Homer could not have suddenly sprung into existence
out of the apparent darkness and ignorance of the centuries
immediately preceding his time.

The State of Medical Knowledge at the Time of the Siege
of Troy. — It is from Homer's Iliad and Odyssey that our
authoritative knowledge of the most ancient Greek medicine
is derived. In the former work mention is made of
Aesculapius and his two sons, Machaon and Podalirius,
both of whom accompanied Agamemnon and the Greek
host in their expedition against Troy. According to this
author's account they served in the double capacity of
surgeons to the army and valiant leaders of troops. In
order that the reader may judge for himself just what is
the nature of the evidence furnished by Homer with regard

48 GROWTH OF MEDICINE

to the medical knowledge of that period, it seems desirable
to introduce here a few of the more characteristic refer-
ences which the poet makes to spear, javelin and arrow
wounds, to the injuries caused by fragments of rocks
hurled by the assailants, and to various remedial measures,
both surgical and medical, employed for the relief of the
wounded or sick warriors. There are at least one hundred
such passages in the Iliad alone, but the few which are here
cited will serve as adequate examples of Homer's famil-
iarity with anatomy and with some of the methods of
treating spear and arrow wounds, — a familiarity which
indicates that the poet must have had some medical training.

Thus he ; and not unmoved Machaon heard :

They through the crowd, and through the wide-spread host,

Together took their way ; but when they came

Where fair-hair 'd Menelaiis, wounded, stood,

Around him in a ring the best of Greece,

And in the midst the godlike chief himself,

From the close-fitting belt the shaft he drew,

With sharp return of pain ; the sparkling belt

He loosen 'd, and the doublet underneath,

And coat of mail, the work of Arm 'rer 's hand.

But when the wound appeared in sight, where struck

The stinging arrow, from the clotted blood

He cleans 'd it, and applied with skilful hand

The healing ointments, which, in friendly guise.

The learned Chiron to his father gave.

(Book lY. of the Iliad, Lines 221-259.)

He said : the spear, by Pallas guided, struck

Beside the nostril, underneath the eye ;

Crashed through the teeth, and cutting through the tongue

Beneath the angle of the jaw came forth :

Down from the car he fell ; and loudly rang

His glittering arms : aside the startled steeds

Sprang devious : from his limbs the spirit fled.

Down leaped Aeneas, spear and shield in hand.

Against the Greeks to guard the valiant dead;

And like a lion, fearless in his strength,

GREEK MEDICINE 49

Around the corpse he stalk 'd, this way and that,

His spear and buckler round before him held,

To all who dar 'd approach him threatening death,

"With fearful shouts ; a rocky fragment then

Tydides lifted up, a mighty mass,

"Which scarce two men could raise, as men are now :

But he, unaided, lifted it with ease.

With this he smote Aeneas near the groin,

"Where the thigh bone, inserted in the hip.

Turns in the socket joint ; the rugged mass

The socket crushed, and both the tendons broke.

And tore away the flesh : down on his knees,

Yet resting on his hand, the hero fell ;

And o'er his eyes the shades of darkness spread.

(The Iliad, Book V., Lines 333-356.)

He said, and passing his supporting hand

Beneath his [Eurypylus'] breast, the wounded warrior led

"Within the tent ; th ' attendant saw, and spread

The ox-hide couch ; then as he lay reclined,

Patroclus, with his dagger, from the thigh

Cut out the biting shaft ; and from the wound

"With tepid water cleans 'd the clotted blood ;

Then, pounded in his hands, a root applied

Astringent, anodyne, which all his pain

Allayed; the wound was dried, and stanch 'd the blood.

(The Iliad, Book XI., Lines 958-967.)
• #****«#«

But Jove-born Helen otherwise, meantime.

Employed, into the wine of which they drank

A drug infused, antidote to the pains

Of grief and anger, a most potent charm

For ills of every name.^ "Whoe 'er his wine

So medicated drinks, he shall not pour

All day the tears down his wan cheeks, although

His father and his mother both were dead,

Nor even though his brother or his son

Had fallen in battle, and before his eyes.

(Book IV. of the Odyssey, Lines 275-284.)
1 Nepenthes, believed to be opium, is the word employed in the original.

50 GROWTH OF MEDICINE

In former years and down almost to the present time,
it was the custom among English medical writers to speak
of Aesculapius only as the ''God of Medicine," thus con-
veying to the minds of many readers that he was a
mythological character, not a real personage. To-day, and
especially since Schliemann has demonstrated, by his
excavations at the site of ancient Troy, that Homer's
Iliad is not merely a beautiful creation of his poetic fancy,
but a narration of events that actually occurred about 1200
B. C, it is quite generally acknowledged that Aesculapius^
is an historical character, an individual whose memory
should receive due honor from the physicians of modern
times. Neither Homer nor Pindar speaks of him as a god.
In Athens he was publicly deified in 420 B. C.

When Daremberg, as quoted above, expressed the belief
that Hippocrates was the product of an earlier civilization,
he undoubtedly gave due weight to other circumstances
beside those which are narrated in Homer's poems —
circumstances, for example, which are referred to casually
by several of the classical Greek authors, and to which
fresh importance has been given by a number of recent
discoveries. Thus, there is an abundance of evidence
showing that the Greeks, both before and after Homer's
time, held the memory of Aesculapius in the very highest
honor. So great, as they believed, was his power over
disease, so wonderful were the cures which he accomplished,
and so noble and pure was his character, that they made
him a god and erected temples in his honor — not mere
places where a barren worship might be carried on, but
veritable sanatoria — termed Asclepieia — where the extraor-
dinary healing powers of him whom they had made a
god might be perpetuated for the benefit of succeeding

2 Aesculapius was held to be the son of Apollo, the god of medicine, and to
have been instructed in the art of healing by Chiron, one of the centaurs.
Beside his famous sons, Machaon and Podalirius, he had four daughters whose
names — Hjgieia, Jaso, Panakeia and Aigle — have come down to us through
the ages. His wife's name was Epione, and those of his two younger sons
were Telesphorus and Janiscus, but all three of these names are rarely men-
tioned by the Greek writers.

GREEK MEDICINE 51

generations. While, on the one hand, the ancient Greeks
may have been full of superstitious beliefs, they were at
the same time as kindly disposed toward their fellow men,
as generous in their spending of money for this purpose,
and as practical in their selection of suitable methods as
are the benefactors of to-day all over the world. In course
of time these so-called temples became the prototypes of
our hospitals, sanatoria and schools of medicine, and it
therefore seems only proper that they should here be
described somewhat in detail.

The so-called Aesculapian Temples and their Chief
Purpose. — The first of these temples, or Asclepieia, were
established at Trikka, in Thessaly ; at Cnidus, on the coast
of Caria in Asia Minor, opposite Cos; at Epidaurus, in
Argolis, Greece ; at Gyrene on the northern coast of Lybia,
Africa, opposite the Island of Crete; at Crotona, on the
southeastern coast of Italy; and, finally, at Athens. It is
said that traces of as many as eighty of these Asclepieia
have been found in different parts of the ancient world.
One of them, for example, is known to have existed on the
small island (Isola San Bartolommeo) in the Tiber, at
Rome. Their management was intrusted, in the earlier
years of their existence, to men who were descendants of
Aesculapius — i.e., the sons and grandsons of Machaon and
Podalirius. They were both priests and physicians, and
are mentioned in history as the Asclepiadae. With the
progress of time it became necessary, as one may readily
understand, to intrust the temple service to individuals
who were not members of the family of Aesculapius. The
original Asclepiadae guarded as valuable secrets the
methods of treatment and the pharmaceutic formulae
which had been handed down to them by the head of the
family. It was therefore natural, when these newly
adopted members were installed in office, that they should
be made to promise, under oath, not to *' divulge these
secrets to any but their own sons, the sons of their
teachers, or the pupils who were preparing themselves to
become regular physicians." (Neuburger.)

The divulging of these secrets, it may be assumed,

52 GROWTH OF MEDICINE

would gradually entail upon the organization of priest-
physicians a serious money loss. As will be seen further
on, the oath known as *'the Hippocratic Oath" omits these
mercenary features, and thus places the vocation of
physician upon a much higher level.

It is an interesting fact, as noted by Hollaender, of
Berlin, that Homer does not make the slightest mention
of temples dedicated to Aesculapius; from which circum-
stance it may be inferred that a long time — perhaps several
hundred years — elapsed, after his death, before his country-
men realized fully his greatness and the value of the
services which he had rendered in his role of physician.
Of the temples which were then built in his honor, all have
long since fallen into ruins, but in recent years excavations
have been made at some of the more important of these
sites and under the guidance of competent scholars, and
as a result our knowledge of the state of medicine in
Greece between the time of Homer and the appearance of
the Hippocratic writings has been greatly enlarged. The
facts revealed by these excavations and the staternents
which are to be found in classical Greek literature, but
which previously did not receive all the consideration that
they deserved, have now been pieced together and we have
thus been furnished with a fairly satisfactory picture of
the relations of the different chambers and spaces in these
temples, and with a more or less complete account of the
manner in which affairs were conducted by those in charge.
The following short description which is based on the
account recently published by Professor Meyer-Steineg of
Jena, Germany, will put the reader in possession of all the
more important facts.*

There were two principal types of Asclepieia — one, like
that of Epidaurus, in Argolis, which occupied an inland
situation, that had clearly been chosen from religious
motives alone, viz., because it was believed, in accordance
with an ancient tradition, that at this spot Aesculapius had

3 ' ' Kranken-Anstalten im grieehisch-romischen Altertum, ' ' von Dr. med. et
jur. Theodor Meyer-Steineg, a. o. Professor an der Universitat Jena; Verlag
von G. Fischer, 1912.

FIG. 1.

VIEW OF THE TEMPLE OF AESCULAPIUS
ON THE ISLAND OF COS.

As it must have appeared to the traveler, in the third century B. C,
on his approach by sea to the port of that island.

Reconstitution based upon recent photographs and upon surveys by
Herzog {Koische Forschungen, 1904).

(Courtesy of^Prof. Dr. Meyer-Steineg, of Jena, Gennany.)

GREEK MEDICINE 53

been born — and a second, like that of Cos, on the island of
the same name in the Aegean Sea, which situation without
doubt had been chosen chiefly because the locality was
exceptionally healthful. Of the first of these two types
of temples, the sites of both of which have been most
carefully studied, very little need be said in this brief
sketch. The purely medical aspects of this Asclepieion,
to which at the height of its celebrity crowds flocked from
all parts of Greece, are of minor interest. The temple and
its accessory buildings, which appear to have been very
extensive, were located in a narrow valley, not far distant
from the seaside village which still to-day bears the name
of Epidaurus. Then, also, the locality is deficient in one
important respect — it has an insufficient supply of good
drinking water; and, finally, it is only slightly elevated
above the sea-level. Dr. Meyer-Steineg remarks that the
patients who visited this temple must have owed whatever
benefit they derived from the visit to other influences than
those of a purely medical or hygienic character. Doubtless
suggestion played an important part in any relief which
they may have obtained, and the so-called temple-sleep was
also doubtless a very effective factor in this direction.
The Asclepieion at Cos, on the other hand, occupied a most
healthful position on the northern slope of the ridge of
mountains which extends throughout the entire length of
the island and attains a maximum height of about 3000
feet. (See Fig. 1.)

It now remains for me to describe, as best I may within
the limited space which is at my command, the results of
the excavations and surveys that have been made in recent
years on the Island of Cos. Professor Meyer-Steineg 's
article on this subject* is the source from which I have
derived the information contained in the following account.

The temple and its associated buildings stood at an
elevation of three hundred feet above the sea-level and at
a distance of a little more than two miles from the city
of Cos. The heights behind the temple were in former

* ' ' Kranken-Anstalten im griechisch-romischen Altertum, * ' in Jenaer
medisin.-historische Beitrdge, Jena, 1912.

54 GROWTH OF MEDICINE

times covered with forests and afforded ample protection
against the debilitating and much-dreaded south wind.
A brook of considerable size and of very pure water passed
through the temple grounds; the spring (Burinna) from
which it took its origin being located about 300 feet higher
up on the side of the mountain. Not far off, in the same
neighborhood, is a mineral spring, the water from which
contains both iron and sulphur. All the physical conditions
of this site were, therefore, very favorable to the restora-
tion of both mental and bodily health. Professor Meyer-
Steineg declares that it is scarcely possible to determine
accurately the age of the Cos Asclepieion, — i.e., of the
structures which the present ruins represent, — but he
believes that some of them date no farther back than the
third century B. C, at which time extensive structural
alterations were made.® Then, at a still later date (first
century A. D.), in consequence of the damage done by an
earthquake, C. Stertinius Xenophon (at the instigation of
the Roman Emperor Claudius, whose private physician
he was) carried out some very radical changes. Not only
were the separate buildings well supplied with running
water, but even many of the individual rooms (of which
there were a large number) were equipped mth the same
conveniences. Hydropathy evidently formed an important
part of the treatment in the reconstructed temple. (See
Fig. 2.)

As has been shown above, the climate, the freedom from
disturbing factors of all kinds, the existence at that spot
of a plentiful supply of pure water, the character of the
structures composing the temple group, and the wide-
spread belief among the people that the Asclepiadae were
able, with the assistance of the god Aesculapius, to effect
cures which were obtainable nowhere else — all contributed
to make the temple at Cos one of the greatest sanatoria of
ancient times.

The buildings which constituted what is commonly
termed the ''Temple of Aesculapius" at Cos were located
on three artificially prepared terraces. The principal

6 All important traces of the earlier structures seem to have disappeared.

rv

FIG. 2. BIRD'S-EYE VIEW OF THE TEMPLE OF AESCU-
LAPIUS AND ASSOCIATED BUILDINGS ON THE
ISLAND OF COS.

As they appeared in the third century B. C.

(Copied by permission from a model made by Prof. Dr. Meyer-
Steineg for the Medico-historical Museum of the University of Jena,
Germany.)

GREEK MEDICINE

55

entrance to the group, as the excavations conducted quite
recently by Herzog show, was on the lower terrace, and
faced north — that is, toward the sea. From this lower
level a broad staircase led to the second or intermediate
terrace, which, in turn, was connected with the upper one
by means of a very broad and massive series of steps. The
southern limit of this upper terrace ended abruptly at the
slope of the mountain. The arrangement of the buildings

M

jllllii'ii' ^

^,m,«iiiiim«\imwt«i«iii«»

Ha fs St at)

W i 8 B 38 •« ia ic ^ ' ti 1i toon

PIG. 3. GROUND PLAN OP THE ASCLEPIEION ON THE ISLAND OP COS.
As Ascertained by the Researches of Dr. Herzogr.

The different structures are arrangred as nearly as possible in the same positions which
they occupied in the third century, B. C.

A, main entrance to Asclepieion; B, B, B, gallery, 6 metres broad, with colonnade on one
side; C. open space or court, on the southern side of which is a structure composed of
recesses provided each with a bathing basin (/?)/ H, staircase leading to intermediate terrace;
a, massive series of steps leading to the upper terrace; *, b, b, broad gallery similar to that
shown on the lower terrace; rf, the temple proper.

(From Prof. Dr. Meyer-Steineg's Medizinisch-historiiche Beitrage.)

56 GROWTH OF MEDICINE

on the three different terraces may, in harmony with the
account given by Professor Meyer-Steineg, be briefly
described as follows: That which stood on the lower
terrace occupied three sides of a parallelogram (Fig. 3),
the open part of which faced south. The longer side of
the building measured about 120 metres (390 feet) in
length, and the two shorter sides each 55 metres (180 feet).
The supply of running water in every part of this great
building, which appears to have been devoted mainly, if
not entirely, to therapeutic purposes, must have been most
abundant. The source from which the water came was the
Burinna spring, situated higher up on the mountain at a
spot far beyond all possibility of contamination. It is not
yet clear, says Dr. Meyer-Steineg, whether or not there
were any buildings devoted to therapeutic purposes on the
intermediate terrace. (Figs. 2 and 3.) On the other hand,
the great halls, contained in the large building which
surrounded the temple on the upper terrace, appear to
correspond very closely to the rooms that constituted the
main portion of the building on the lower terrace, and it
is therefore probable that this upper building also served
some useful purpose in the general scheme of the Ascle-
pieion. It is Herzog's opinion — according to Meyer-
Steineg — that the central idea around which everything
in this assemblage of fine buildings revolved, was a clinic
conducted by the Asclepiadae. The means chiefly employed
at first for the restoration of health were such simple
agents as sunlight, pure air, pure drinking water, dietetic
measures, massage, physical exercise, etc., and yet, when
the patient's condition seemed to require their use, there
was no hesitation in resorting to the rational employment
of drugs, and even surgical operations were performed.
The numerous instruments which Dr. Meyer-Steineg col-
lected at the site of the ruins when he visited Cos in 1910,
furnish ample corroborative evidence of the correctness
of this last statement.

Not the least important part which this famous Ascle-
pieion played in the history of medicine was the splendid
opportunity which it afforded to those who were preparing

GREEK MEDICINE 57

themselves to engage in the practice of the healing art, for
acquiring the necessary familiarity with the different
diseases and for learning how they should be treated.

The manner of conducting the preliminary treatment was
probably not the same in every particular in all the different
Asclepieia, and yet in the main the plan of procedure
followed in Epidaurus, in Cos and in Athens undoubtedly
resembled closely that which Pagel furnishes in his
Geschichte der Medizin. It may be briefly described as
follows : —

In the first place, moribund persons, the unclean, and
women about to be confined were not admitted into the
temple enclosure. The management of the latter class of
patients was left entirely to women nurses, and, when it
became evident that a person was likely to die, the indi-
vidual was thereafter cared for outside the enclosure.® In
short, everything possible was done to keep out of sight
all such objects as might produce an unpleasant impression
upon applicants for treatment. After preliminary bathing
and dieting, the patient was conducted into the temple
enclosure and encouraged to make offerings and to pray
to the god Aesculapius, an imposing statue of whom in
marble was one of the first things that confronted him.
As he was led about by the priest or an attendant, his
imagination was wrought upon by the sight of numerous
votive offerings exposed to view on the walls or columns
of the buildings, by the singing of hymns in adoration of
the god, and by the reading of the records of earlier cases
inscribed on tablets or on the columns. After his mind had
thus been worked upon, he was asked to furnish to the
priest a detailed history of his own case and to submit to
some sort of physical examination. As a final and most
important step in this first stage of the treatment he was
subjected to what was termed ''the temple-sleep," during
which the suggestion of the proper remedies to be employed
was supposed to be communicated to him by the god himself.

« The Emperor Antoninus Pius, in order to provide properly for these
patients, erected at Epidaurus a special building in which confinement cases
and those likely to end fatally might be lodged.

58 GROWTH OF MEDICINE

In our day it is difficult to understand how persons of
a fair degree of intelligence could for so long a period have
continued to believe in the efficacious interference of the
deified Aesculapius in their behalf. But that this belief
really did exist is well known, and it was only after the
lapse of many centuries that the faith of the public began
to weaken, doubtless through the influence of several
factors. Perhaps the most important of these was the
discovery of an increasing number of instances of hum-
buggery or trickery, of which the officiating priests, in some
of the temples, had been guilty. The satirical writer,
Aristophanes, who flourished in Athens about 400 B. C,
describes an incident of this nature in his play entitled
*'Ploutos." The following extracts furnish an account of
the doings observed by the slave Karion on the occasion
of his passing a night in the temple enclosure at Athens : —

The Scene throughout is laid at Athens, in front of the
house of Chremulos.

Blepsidemos : Ought n't we then to bring in some doctor?

Chremulos: Prythee, what doctor is there now in the city?
For their pay is no longer anything worth, nor their art.

Blep. : Let us cast about.

Chrem.: Nay, there is not one.

Blep. : I believe there is not.

Chrem.: Nay, by Zeus, the best plan is to do what I have been
long preparing — (to conduct him [Ploutos] ) to the temple of
Asklepios [and] make him lie down [there].

Chrem.: Karion, my man, you must bring out the bed-clothes
and lead Ploutos himself in the usual way, and carry everything
else that is ready within.

{Exeunt omnes.)

Chorus of Farthers. What is the matter. Oh thou best friend
of — thyself? For you seem to have come as a messenger of some
good news.

GREEK MEDICINE 59

Karion!' My master has fared most prosperously, or rather
Ploutos himself. For, instead of being a blind man, he has been
made to see again, and his pupils are clear-sighted, as he has met
with a kindly friend in Asklepios the Healer.

Chorus. You give me reason for joy, reason for shouts of
triumph.

Karion. Ye have reason to rejoice whether ye wish it or not.

Chorus. I will shout aloud for Asklepios of the goodly children,
the great light to mortals.

• *••••••••

Karion. Well, as soon as ever we came to the god, leading a
man then, indeed, most miserable, but now blessed and fortunate,
if any other is so, first we led him to the sea, and then we bathed
him.

Wife of Chremulos. By Zeus, then the old man was fortunate,
bathing in the cold sea.

Karion. Then we went to the sacred enclosure of the god. And
when on the altar the cakes and offerings were dedicated by the
flame of murky Hephaistos, we laid down Ploutos, as was proper;
and each of us made up from little odds and ends a bed for himself.

Wife. Then were there certain others beside yourselves wanting
the god ?

Karion. Yes, Neokleides, for one, and he is blind; but in
stealing has far overshot those who can see ; and there were many
others with all sorts of ailments. But when the minister of the
deity put out the lights and told us to go to sleep and said that we
were to keep silent, if any of us perceived a noise, we all lay down
in an orderly manner. And I was unable to sleep, for my attention
was arrested by a certain pitcher of porridge a little way off from
the head of a certain old woman, and, I strangely desired to creep
over to that pitcher. Then I looked up and saw the priest making
a clean sweep of the cakes and dried figs from the sacred table.
After this he went round all the altars in a circle to see if any
cakes were left anywhere. Then he consecrated them into a certain
wallet; and I, believing that there was great holiness in this
proceeding, rise up to go to the pitcher of porridge.

Wife. Oh you most miserable of men, were you not afraid of
the god?

Karion. Yes; by the gods I was afraid lest he with his fillets
should reach the pitcher before me; for the priest had already

' The slave of Chremulos.

60 GROWTH OF MEDICINE

given me a lesson. But, as soon as ever the old woman perceived
the noise I made, she lifted up her hand over the pitcher (to protect
it). Then I hissed and seized (her hand) by the teeth as if I were
a reddish-brown snake. But she at once drew back her hand again
and lay down peacefully, rolling herself up. And then I at once
gulped down a lot of the porridge; and then, when I was fuU, I
jumped up again.

Wife. And didn't the god come up to you?

Karion. Not up to that time. After this I at once covered
myself up, being afraid ; but he made a complete circuit examining
all the ailments in a most orderly fashion ; and then a slave set by
him a little mortar and box of stone.

Wife. Of stone ?

Karion. No, by Zeus, certainly not, — at least, not the box.

Wife. To the deuce with you, how did you see since you say
you were covered up ?

Karion. Through my old cloak; for, by Zeus, it had holes not
a few. First of all, he took in hand to pound a plaster for Neo-
kleides, and he threw in three cloves of Tenian garlic. Then he
bruised them in the mortar, mixing therewith the acid juice of the
fig-tree and squill ; then, having diluted it with Sphettian vinegar,
he turned his eyelids inside out that he might feel more pain, and
then applied the mixture. But he, squalling and bawling, jumped
up and was running away, when the god said with a laugh : — * ' Sit
down there now, smeared with thy plaster, that I may stop thee
from going to the Assembly, having for once a real excuse. ' '

Wife. What a patriot and sage the god is !

Karion. After that he sat down by the side of Ploutos, and
first he touched his head, and then, taking a clean towel, he wiped
his eyelids all round, and Panakeia covered his head and all his face
with a cloth of purple dye ; and the god then whistled. Thereupon
two snakes of monstrous size darted forth from the temple.

Wife. Dear Gods !

Karion. And these two (snakes) having quietly glided under
the crimson cloth, licked his eyelids all around, methought. And
before you could drink ten cups of wine, my mistress, Ploutos
stood up and was able to see : and I clapped my hands with delight
and awoke my master. And the god suddenly took himself off
from our view with the snakes into the temple.

If one examines carefully the facts connected with the
Aesculapian temple treatment, so far as they are known

GREEK MEDICINE 61

to us, one cannot fail to be impressed with their strong
resemblance to what has been the experience of similar
semi-religious movements in more recent times, not only
in European countries but also in the United States. In
all of them there may be found a kernel of true religious
belief, and no candid observer can deny the fact that many
persons have been benefited thereby both in body and in
mind. But, sooner or later, the method has fallen into
disrepute, either because it was employed in the vain hope
that it might accomplish a cure which surgical means alone
could effect, or else because unscrupulous persons, taking
advantage of the credulousness of those associated with
the movement, utilized it for their own selfish advantage.

CHAPTER V

THE SIGNIFICANCE OF THE SERPENT IN THE
STATUES AND VOTIVE OFFERINGS EXPOSED
TO VIEW IN THE AESCULAPIAN TEMPLES

Almost every important gallery of sculpture in Europe
possesses at least one marble statue of Aesculapius, and in
the majority of these the god is represented as a middle-
aged or elderly man of powerful frame, having a full head
of hair and full beard, and clothed only with the pallium
or mantle, which is so placed as to leave the right shoulder
and a large part of the chest uncovered. He holds in his
right hand a knotted staff around which, in many of the
statues, is coiled a serpent whose head approaches very
closely to the hand. The expression of the god's counte-
nance is strikingly peaceful and serene, yet without any
evidence of weakness. In not a few instances other animals
are represented alongside the statue, usually at the god's
feet — as, for example, the cook, the owl, the eagle, the hawk
or the ram — and occasionally his daughter Hygieia is
shown at his side feeding the serpent. The cock is the
symbol of watchfulness — a physician should be vigilant;
the owl symbolizes his need of clearsightedness and of
readiness to care for his patients in the night as well as
during the day; the eagle has a penetrating eye and it is
the emblem of long life — a benefit which the healing art is
capable of procuring; the hawk was the bird consecrated
to Isis, Queen of Egypt, who was believed by the Egyptians
to have been highly skilled in medicine ; and the ram is the
symbol of dreams and divination. Pliny says that the
patients who were brought to the temple of Aesculapius
were made to lie down at night wrapped in the skin of a

'-V

HEAD OF THE

MARBLE

STATUE OF

THE GOD

AESCULAPIUS

IN THE

NAPLES

MUSEUM

FIG. 4. ANCIENT STATUE OF THE

GOD AESCULAPIUS IN THE

BERLIN MUSEUM.

(From Hollander'.s Plaslik und Medizin, with
the author's permission.)

SIGNIFICANCE OF THE SERPENT 63

ram, in order that they might have divine dreams. The
presence of the serpent in nearly all of the statues of
Aesculapius is explained in a variety of ways. Some say
that this reptile, which sheds his skin once a year, is
emblematic of the sick person 's need to acquire a new body,
or at least cast off his old skin in the same manner as does
the snake. Others consider the serpent as merely the
symbol of wisdom, as it is admittedly the shrewdest and
most cunning of all animals. In a few instances it is
represented as drinking from a receptacle held in the hand
of Hygieia. Perhaps the sculptor's intention here was to
show that the serpent, although the wisest of all animals,
believed that he might add to his stock of wisdom by
drinking from the fountain under the control of Aescula-
pius, thus conveying the impression that the wisdom of the
latter was greater than his own. But all these interpre-
tations are too subtle for the uneducated mind to appre-
ciate at a glance. They fail also to satisfy our preconceived
ideas of what such a statue should be — viz., a memorial of
the godlike character of Aesculapius and of the priceless
benefits which he conferred upon his fellow men, and, at
the same time, an object which, when first contemplated
by one who is ill, would at once evoke in that person feelings
of perfect confidence in the ability and the willingness of
the god represented by the statue to effect a cure. Some,
perhaps even a majority, of the statues thus far recovered
from the ruins of the different Aesculapian temples cer-
tainly fail to arouse any such sentiments in the minds of
ordinary observers ; but there are others which do in some
measure accomplish this, and among the number the statue
which may be seen in the Berlin Museum ancj of which a
photographic copy (Fig. 4) is here reproduced, should
certainly be included. The head of the god is less imposing
and the expression less kindly than are these features in
some of the other statues (see, for example. Fig. 5), but,
to offset this, the serpent represented in the latter is of
the non-poisonous variety.^ The addition of such a harm-
less creature to the figure representing the god contributes

1 To save space the head of the god alone has been reproduced in Fig, 5.

64 GROWTH OF MEDICINE

nothing to the power of the statue as a whole to impress
the people — i.e., the uneducated masses, as, for example,
the peasants, etc. On the other hand, the significance of
the poisonous snake in a statue of this character will be
readily appreciated if one considers the fact that in ancient
times, as it is even to-day in India, the loss of life caused
by the bites of poisonous snakes was enormous. In the
presence of such a fact, therefore, it would be difficult for
a sculptor who was desirous of emphasizing the extraor-
dinary healing powers of his hero to accomplish this more
effectively than by embodying in his statue, along with
other impressive features, such characters as would show
him to have gained the mastery over that terribly fatal
malady — the bite of the viper and of the still more deadly
serpents of India and parts of Africa. Although we
possess no facts which would warrant the statement that
Aesculapius had been particularly successful in the treat-
ment of this form of poisoning, these temple statues furnish
indirect proof of a strong character that his healing power
in this direction had been very great, — so great, indeed,
as to have been largely instrumental in winning for him
the appellation of a god. Such a striking object, especially
when its more important features were commented upon
by the priest who accompanied the patient on his or her
first tour of inspection of temple wonders, could scarcely
have failed to produce a very deep impression upon the
imagination.

In the illustration which has here been reproduced
(Fig. 4), a viper, as clearly shown by the shape of his head
and neck and by the unusual length of the jaw, has twined
himself about the staff and is close to the god's hand, so
close that in an instant's time the fatal bite might readily
be inflicted. But Aesculapius shows by his countenance, by
the unconcerned manner in which he allows his right hand
to remain near the serpent's head, and by the easy pose
of his whole body, that he is not at all concerned about the
danger which appears to threaten his life. In the estima-
tion of the ancient Greeks this fearlessness was undoubt-
edly attributed to the supernatural power which they

SIGNIFICANCE OF THE SERPENT 65

believed Aesculapius to possess over dangerous serpents
as well as over diseases of all kinds.

So far as now appears, all the statues of the god that
have been dug up in Greece or its nearest colonies represent
the serpent as of the size commonly observed in that part
of the world. HoUaender, however, furnishes (on page 118
of his work) an illustration which represents — as Ije
believes — the god Aesculapius in the presence of an
enormous snake, evidently a python. ( Fig. Q.) yAs this
variety of serpent is not to be found in Greece, or indeed
at any point further north than the Mediterranean coast
of Africa, it is fair to assume that the bas-relief which
depicts this scene must have been made for exhibition in
an Asclepieion located at Cyrene or at the relatively near
city of Alexandria, where patients, who were more or less
familiar with this serpent and realized its power of
crushing people to death, would have occasion to witness
this suggestive work of art. And, furthermore, as if it were
for the express purpose of emphasizing the great protective
power of the god, the sculptor has introduced, on one side
of the scene, the figures of three women, two young children
and a lamb. The women nearest to the monster have
folded their arms and do not manifest the least sign of fear.
The children also appear to be unaware of the presence
of a deadly danger. In short, the proximity of the god
Aesculapius has instilled into the minds of these human
beings the most complete sense of fearlessness ; he himself,
as in the case of the statue of Aesculapius shown in Fig. 4,
exhibiting a complete absence of fear in the presence of
the dangerous monster. Neither death by poisoning nor
death by constriction has any terrors for him to whom
the patient is about to appeal for relief from disease.

That pythons were a terror in former times to the people
who inhabited the coast regions near Cyrene is evident
from a statement which Aristotle makes in his History
of Animals (Book VIII., Chapter xxviii.). It reads as
follows : —

In Libya (Africa) the serpents, as has been already remarked,
are very large. For some persons say that, as they sailed along

66 GROWTH OF MEDICINE

the coast, they saw the bones of many oxen, and that it was evident
to them that they had been devoured by the serpents. And, as
the ships passed on, the serpents attacked the triremes, and some
of them threw themselves upon one of the triremes and overturned
it.

CHAPTER VI

THE BEGINNINGS OF A RATIONAL SYSTEM OF
MEDICINE IN GREECE

With the lapse of time the religious and mystical features
of the treatment carried on at the Asclepieia gave place,
more and more, to rational methods, and eventually — it
is scarcely possible to mention a date, but probably not
many years before the Hippocratic period — these institu-
tions became centres for the spread of medical knowledge
of the most practical kind. This is particularly true of the
Asclepieion at Cos, where Hippocrates is believed to have
received his medical training. It is interesting to note that
the ijaystical features of the temple treatment — features
which certainly did not originate with Aesculapius himself
or with his sons, Machaon and Podalirius — eventually
proved powerless to stay the slow but sure advance of
sound medical knowledge. Even during the period when
these false elements seemed to be most strongly rooted
in the temple methods, there were forces at work which
in due time deprived them of much of their pernicious
power. This result was inevitable, for an organization
which, in order to prosper in its work of doing good to
humanity, depended upon the natural superstitiousness of
the people, could not possibly thrive for an indefinite
length of time. That the evil results did not develop sooner
than they did simply shows how powerful and stubborn is
the force of superstition. In the absence of trustworthy
historical evidence, hypothetical statements only can be
brought forward, but there can scarcely be any doubt but
that a genuine belief in the power of Aesculapius (deified)
to cure disease and restore health persisted for centuries.

The custom of recording the case histories on tablets or

68 GROWTH OF MEDICINE

on the colunms of the temple, — for at this period writing
was in general use, — and also that of dedicating to the god
images which represented (sometimes with a remarkable
degree of truthfulness) the pathological condition for
which the patient sought relief, contributed very greatly
to the substitution of sound learning for religious mysticism
and poorly concealed humbuggery.

Among the interesting objects which may be seen at the
Museum of the History of Medicine in Jena, Germany,
there are several of these terra-cotta images (votive
offerings) representing pathological conditions; and
among them the writer noticed more particularly one
which reproduced faithfully, though in diminutive size, the
appearances presented by cancer of the female breast.
(Fig. 7.) There were also a very carefully modeled
statuette of the trunk of a woman affected with ascites,
and an admirable representation of a case of facial
paralysis. (Fig. 8.) These objects were obtained by
Professor Meyer-Steineg on the occasion of a recent visit
to the ruins of the temple of Cos and other similar ruins
in Greece and Asia Minor. The British Museum possesses
many objects of the same character.

It is not known at what precise date the iatreia, or small
private hospitals, first made their appearance, but it was
about the time when the religious character of the thera-
peutic work done in the Asclepieia gave place to treatment
of a more distinctly medical character. Then, in addition
to these iatreia, there were schools for gladiators and
institutions in which gymnastic exercises were zealously
cultivated ; and in these places there was a frequent demand
for advice in regard to questions of diet, and for surgical
aid in the setting of broken bones, the reducing of dis-
locations, and the curing of bruises and sprains. As may
readily be understood, the Asclepieia could not furnish the
sort of professional aid which these institutions needed,
and thus a further stimulus was given to the complete
separation of the two kinds of medical practice — that
connected with the temple and that conducted by outside
physicians.

jS£BC-"w»-

I i(.. o. BAS-RELlKi- (;i- AESCULAPIUS. ACCOMPANIED BY WOMEN

AND CHILDREN, IN THE PRESENCE OF AN

ENORMOUS SERPENT.

The original is in the National Museum at Athens.

FIG. 7. FEMALE BUST SHOWING CANCER OF ONE BREAST.
(Courtesy of Prof. Dr. Meyer-Steineg, of Jena, Germany.)

BEGINNINGS OF A RATIONAL SYSTEM 69

In Plato's ''Republic" (Book III., Chapter 15) mention
is made of a certain Herodicus (of Selymbria; about
450 B. C.) who effected many cures by a method of treat-
ment which combined athletic exercises with dieting. He
gained considerable celebrity in this way, and is undoubt-
edly entitled to the credit of having been the first to call
serious attention to the value of this plan of treating
certain maladies. But, unfortunately, he made use of it
in not a few instances where it proved harmful rather than
beneficial to the patient, and thus brought discredit upon
the method.

Already previous to the time at which the changes
mentioned above took place, there had occurred still other
changes in the character and practice of medicine. The
business of cutting for stone in the bladder, for example,
had been left entirely in the hands of men who made a
specialty of this branch of medicine — men who might
truthfully be called medical artisans. Then there was
another class of men who devoted their energies to col-
lecting medicinal roots and plants. They were a necessity
to physicians, and constituted the first representatives of
the modern apothecary. Still another change in the status
of the Greek physicians had been slowly developing
throughout this pre-Hippocratic period, a change which
tended more and more to make them men of self-reliance
and of considerable importance in their respective com-
munities, and which indicated very clearly that they were
steadily growing in skill and breadth of knowledge. As
evidence of the correctness of this statement it is sufficient
to mention the fact that Greek physicians had established
so good a reputation that they were frequently called to
see important cases at a great distance — in Egypt, in
Persia, etc. But before further consideration is given to
this subject of the development of the Greek physician
during the period immediately preceding the appearance
of the Hippocratic writings, it seems advisable to say a
few words concerning the facilities for medical instruction
which were available at that time.

Medical Instruction in Connection with the Asclepieia. —

70 GROWTH OF MEDICINE

It does not appear clearly in any of the published descrip-
tions of these ancient Greek sanatoria just what were the
relations between the priests and the men who utilized all
this rich clinical material — records of all sorts of diseases,
and the means (other than religious) employed in treating
them, pictures or plastic reproductions of the visible
pathological lesions, etc. — for the purpose of instructing
the younger men who contemplated engaging in the
practice of medicine. The modern teachers of the art know
very well how difficult is the task of combining in a satis-
factory manner these two things — the safeguarding of the
patient's interests and the utilization of their maladies as
object lessons for men who are preparing to cure or relieve
the bodily ills of those who may at some future moment
need their professional services. To them, therefore, it
would be a matter of very great interest to learn how
this difficult problem had been solved nearly twenty-five
hundred years ago. But, unfortunately, no satisfactory
data upon which a trustworthy account might be founded
are obtainable, and we are obliged to fall back upon such
aid as our imagination may furnish. From Puschmann's
work on medical teaching in ancient times the following
statement relating to the subject has been taken : —

The priests in the Aesculapian temples were not, as is generally
assumed, physicians in the ordinary sense. They may have
acquired some knowledge of the art, and they may even in some
instances have been regularly trained physicians, but the important
fact remains that they wished it to be understood that the treatment
carried out in the temple was in accordance with revelations made
to them by the god Aesculapius, and not the mere fruit of human
knowledge. Consequently the intervention of regular physicians
in the temple management of the sick must have appeared to them
quite superfluous. For this reason, therefore, it is not likely that
there existed, on the part of either the temple priests or the
physicians, any feeling of animosity or opposition. It is more
likely that the contrary was the case, for the evidence shows that
the physicians — the Asclepiadae — paid most humble reverence to
the sacred relics of Aesculapius, and placed the most implicit
confidence in the opinions which he was supposed to give in
desperate cases.

70 -

FIG. 8. PARALYSIS OF THE LEFT
FACIAL NERVE.

(Courtesy of Prof. Dr. Meyer-Steinegr, Jenaer medi-
zinisch-hislorische Beiirage, Heft 2, 1912.)

BEGINNINGS OF A RATIONAL SYSTEM 71

While Puschmann does not say to what period in the
history of these temples his statement applies, it is safe
to assume that he had in mind only the earlier stages.
When the systematic teachings of medical pupils began,
those physicians who gave the instruction — ^viz., the Ascle-
piadae who were not at the same time priests — took up their
abode somewhere in the neighborhood of the temple. Thus,
medical schools were formed at different places, those of
Rhodes, Crotone, Cyrene, Cos and Cnidus attaining the
greatest celebrity. The pupil paid a fee for his instruction,
and when his training was believed to be completed he was
admitted into the association or brotherhood of the
Asclepiadae upon taking the following oath, which for ages
past has been known as **The Hippocratic Oath,'* but
which is now believed to have been formulated long before
the time of Hippocrates : —

THE HIPPOCRATIC OATH

I swear by Apollo the Physician and Aesculapius, and Hygieia
and Panacea and all the gods and all the goddesses — and I make
them my judges — that this mine oath and this my written engage-
ment I will fulfil as far as power and discernment shall be mine.

Him who taught me this art I will esteem even as I do my
parents; he shall partake of my livelihood, and, if in want, shall
share my goods. I will regard his issue as my brothers and will
teach them this art without fee or written engagement if they shall
wish to learn it.

I will give instruction by precept, by discourse, and in all other
ways, to my own sons, to those of him who taught me, to disciples
bound by written engagements and sworn according to medical
law, and to no other person.

So far as power and discernment shall be mine, I will carry out
regimen for the benefit of the sick and will keep them from harm
and wrong. To none will I give a deadly drug even if solicited,
nor offer counsel to such an end ; likewise to no woman will I give
a destructive suppository; but guiltless and hallowed will I keep
my life and mine art. I will cut no one whatever for the stone,
but will give way to those who work at this practice.

Into whatsoever houses I shall enter I will go for the benefit
of the sick, holding aloof from all voluntary wrong and corruption,
including venereal acts upon the bodies of females and males

72 GROWTH OF MEDICINE

whether free or slaves. Whatsoever in my practice or not in my
practice I shall see or hear amid the lives of men which ought not
to be noised abroad — as to this I will keep silence, holding such
things unfitting to be spoken.

And now if I shall fulfil this oath and break it not, may the
fruits of life and of art be mine, may I be honored of all men for
all time ; the opposite if I shall transgress and be forsworn.

(Translated from the Greek by the late John G. Curtis, M.D., of
New York.)

While at first, according to Puschmann, many physicians
did not belong to the Aesculapian Brotherhood, there came
a time when all were known as Asclepiadae.

Influence of the Schools of Philosophy on the Growth of
Medical Knowledge. — About the beginning of the sixth
century B. C. there developed, in Greece and its colonies,
schools of philosophy which exerted a most excellent
influence upon the growth of medicine. The first of these
was the one known as the Ionian School, whose founders
and chief representatives were Thales, of Miletus in Ionia
(born in 640, died in 548 B. C), and his pupils Anaximander
and Anaximenes. The guiding principle of these men was
to study natural phenomena and to learn, if possible, their
causes and the laws of their action. Physiology, therefore,
became one of their special studies, and thus they con-
tributed to the laying of one of the most important
foundation-stones of medicine. Thanks to the good
quality of the work of instruction that had thus far been
carried on at Cos, Cnidus, and other Asclepieia, medicine
had by this time reached a sufficient degree of development
for its devotees to derive a full measure of benefit from
the new teaching of the philosophers. Well grounded in
the observation of disease in its different forms and modes
of behavior, and also familiarized with the ordinary
methods of treatment, these physicians needed to be shown
a new route along which they might advance to greater
heights of knowledge, and they also needed to be stimu-
lated to further endeavor. The introduction of the new
school accomplished both of these purposes. It taught the
men of the older organizations that they must make much

BEGINNINGS OF A RATIONAL SYSTEM 73

greater use of their reasoning powers than they had
hitherto done, and at the same time, through the creation
of a group of rival physicians, it supplied them with the
required stimulus. Another important school of philosophy
was that known as the Eleatic School, which flourished at
Elea, in Lower Italy, its leaders being natives of that city.
The most prominent men connected with this school were
Parmenides (born about 540 B. C.) and Xenophanes of
Colophon, in Asia Minor, whose contributions to mental
science formed the basis of Plato's metaphysics.

The period roughly embraced between the years 500 and
300 B. C. represents the most brilliant age of Greek
intellectual and artistic activity. During this time there
came into prominence such philosophers, historians, poets,
physicians, artists and generals of armies as had never
before been marshaled in historic array in so rapid
succession. Even at this late day the names of these great
men are almost household words — such names, for example,
as Pythagoras, Alcmaeon, Anaxagoras, Aristotle, Plato,
Socrates, Sophocles, Aeschylus, Euripides, Aristophanes,
Pindar, Xenophon, Demosthenes, Democedes, Hippocrates
the Great, Phidias, Praxiteles, Zeuxis, Apelles, Darius I.,
Alexander the Great, and many others of almost equal
celebrity. During the centuries immediately preceding
this golden age of Greek history, there seem to have
been very few men of great merit in any of the branches of
learning or in the fields of war or art, but this impression
is certainly false. It is doubtless to be explained by the
fact that large quantities of documentary evidence relating
to these years have been entirely lost. Daniel Le Clerc,
for instance, states^ that, of the separate histories of the
descendants of Aesculapius which were written by Eratos-
thenes, Pherecydes, ApoUodorus, Arius of Tarsus and
Polyanthus of Cyrene, not one has come down to our
time. If, then, in the single department of medicine,
the destruction of documentary evidence was as great as
is here represented, how enormous must have been the
loss of precious historical materials in all the departments

1 Histoire de la Medecine, Amsterdam, 1723.

74 GROWTH OF MEDICINE

of human activity taken together. We may, therefore,
safely assume that this golden age, which lasted only about
two hundred years, represents simply the culmination of
an even longer period of slow but steady development,
a period of creditable though perhaps less brilliant
achievements.

Of the names mentioned above there are several that
belong to men who were in various ways connected with the
early history of medicine. Pythagoras, for example, is
said to have been one of the first among the Greek philoso-
phers to exert a strong and double impression upon the
medical teaching of that period. He was born in the Island
of Samos, near the coast of Asia Minor, about the year
575 B. C. After spending several years in Egypt for
purposes of study, and probably visiting Babylon, at' that
time a great centre of learning and of artistic cultivation,
he established at Crotona, in the south of Italy, a schooP
where natural philosophy, mathematics, acoustics, etc.,
were taught. He also devoted some attention to anatomy,
to embryology, to physiology and to therapeutics. Accord-
ing to his views of what constituted hygienic living a man
should accustom himself to a diet of the simplest character,
without meat. Pythagoras was a believer in the Chaldean
doctrine that the uneven numbers possess a more important
significance than the even, and that the number seven in
particular has a special relationship to the phenomena
of certain diseases; the crisis frequently falling on the
seventh, fourteenth, or twenty-first day. Galen, it is said,
expressed surprise that a man as sensible and learned as
Pythagoras should have paid any attention to such trifles.
Not a few of the disciples of Pythagoras were physicians,

2 The word ' ' school, ' ' when employed in the strictly modern sense of that
term, means an establishment regularly organized for the purpose of giving
instruction. Here, however, it is intended to signify simply that certain places,
like Cos, Crotona, Cnidus, etc., had become the rendezvous of men who desired
to cultivate — some as teachers, others as disciples or pupils — certain branches
of knowledge, or certain doctrines. At a later period (third century B. C.)
there was established at Alexandria, Egypt, a well-organized school of medi-
cine closely resembling those of modern times.

BEGINNINGS OF A RATIONAL SYSTEM 75

and when the brotherhood (if such it may be called) broke
up, as it did in the fifth century B. C, these men traveled
about from one Grecian city to another; from which fact
they were given the name of * * periodeuts " or ambulant
physicians. Crotona was also celebrated as the birthplace
of Milo, the athlete.

Democedes, who was a contemporary of Pythagoras, but
not one of his disciples, was a native of Crotona. Dion
Cassius, the author of a Roman history, ranks him and
Hippocrates as the two most eminent physicians of
antiquity. Daremberg, who derived his facts from the
works of Herodotus, gives the following account of the
adventures of Democedes : —

Being unable to bear any longer the frequent anger and harsh
treatment of his father, Calliphon, Democedes left Crotona, and
settled in practice at Aegina, on the Saronic Gulf, not far from
Athens. Almost from the very start he attained marked success,
and already in the second year of his residence in Aegina he was
made the recipient of a pension of one talent (equal to about £240.
or $1200.) out of the public treasury. During the following year
he was induced, by the offer of a larger pension (100 minae, or
about $3000.) to settle in Athens; and, a year later, he accepted
a still larger remuneration from Polycrates, the tyrant of Samos.
Having accompanied the latter on a trip to Sardis, the capital of
Lydia, in Asia Minor, he fell a prisoner into the hands of the
governor of that city, and was made by him a slave. Not long
afterward Darius gained possession of this governor's or satrap's
property, including all his slaves; and thus, despite all his efforts
to conceal his profession through fear that a knowledge of it on
the part of the king might prolong his bondage indefinitely,
Democedes was unable to do so. The discovery came about in the
following manner. During a hunting trip Darius broke his ankle.
He called to his assistance the court physicians, who were esteemed
the most skilful that could be found in all Egypt, but they failed
to give him relief. By the violence of their manipulations they
rather made matters worse. For seven days and nights his
sufferings were so great that he was unable to obtain any sleep.
Finally, on the eighth day, one of the court attendants having told
Darius that there was a Greek physician among the slaves,
Democedes was sent for, and he appeared before the king clad in

76 GROWTH OF MEDICINE

rags and with chains on his ankles. When asked whether he knew
anything about medicine he denied such knowledge, being fearful
that the discovery of the truth about himself would stand in the
way of his ever getting back to Greece. Darius, perceiving that he
was dissimulating, ordered the attendants to fetch the whips and
pinchers. Whereupon Democedes made up his mind that he had
better confess the truth. He accordingly told the king that, while
not possessing a thorough knowledge of the healing art, long
association with a physician had familiarized him more or less
with the subject. The king then asked him to take charge of the
case. Democedes, following the treatment adopted by the Greek
physicians in similar conditions, applied soothing remedies and
soon succeeded in procuring sleep for the suffering king. Event-
ually he obtained a complete cure, and Darius, who had made up
his mind that he would never again be able to use his limb, was
naturally delighted with the result. He loaded Democedes with
gifts, and, being charmed with his conversation, made him sit at
the royal table and did everything possible to render court life
attractive; but liberty was denied him, which was the one thing
that Democedes most ardently desired. The only use which the
latter made of the great influence which he had obtained over
Darius was to save the Egyptian physicians from the death by
crucifixion which the king had decided to inflict upon them for
their lack of skill.

The means of escape finally presented themselves to Democedes
in a most unexpected manner. Atossa, who was the wife of Darius
and also the daughter of Cyrus, was afflicted with a swelling of
the breast which developed into an abscess and began to burrow
into the neighboring tissues. After, for a time, concealing the
trouble through a sense of false modesty, she made up her mind
to consult Democedes. He had the good fortune to cure her of
this malady in a relatively short time. As preparations were then
being made to send a number of spies to Greece with instructions
to examine the coast carefully for the purpose of determining at
what points the defenses were sufficiently weak to render an attack
by the Persians reasonably sure of success, Democedes asked
permission of Darius to accompany these men as their guide. His
request was granted; and, as soon as the expedition reached
Tarentum in Calabria, he delivered the Persian spies into the
hands of Aristophilides, the king of that country, and then fled
in all haste to Crotona, his native city. Shortly afterward these
Persians, having been set at liberty by Aristophilides, made the

BEGINNINGS OF A RATIONAL SYSTEM 77

attempt to capture Democedes and carry him off by main force,
but the citizens of Crotona thwarted the attempt and compelled
the men to return to Asia. Democedes then married the daughter
of Milo, the athlete, and history furnishes no information regarding
the subsequent career of this extraordinary man.

Daremberg calls attention to certain excellent proverbs
which may be found in the writings of the Greek poets and
which are of some interest to physicians. The following
may serve as examples of those most widely known : — *

Joy is the best physician for fatigue.

(Pindar, 522-442 B. C.)

The good physician is he who knows how to employ the right
remedies at the proper time ; the poor one, he who, in the presence
of a serious illness, loses his courage, becomes flustered, and is
unable to devise any helpful method of treatment.

(Aeschylus, 525-456 B. C.)

Physician, heal thyself.

(Euripides, 400-406 B. C.)

Advice given to Phaedra by her nurse :-

If thou hast some ailment which thou dost not care to reveal to
men, here are women who are competent to treat the condition
properly.

(Euripides.)

Sleep is the physician of pain,
and

Death is the supreme healer of maladies.

(Sophocles, 495-406 B. C.)

In Plato's writings there are to be found a few passages
in which this philosopher gives his views in regard to
certain matters that are not without interest to modern
physicians. The following extracts are of this nature: —

There is not then, my friend, any office among the whole inhabi-
tants of the city peculiar to the woman, considered as a woman,

3 All of these are translations from the French.

78 GROWTH OF MEDICINE

nor to the man, considered as a man; but the geniuses are
indiscriminately diffused through both: the woman is naturally-
fitted for sharing in all offices, and so is the man; but in all the
woman is weaker than the man.

Perfectly so.

Shall we then commit everything to the care of the men, and
nothing to the care of the women ?

How shall we do so ?

It is therefore, I imagine, as we say, that one woman, too, is
fitted by natural genius for being a physician, and another is not ;
one is naturally a musician, and another is not.

(From "The Republic" of Plato, translated by Spens.)

But tell me with reference to him who, accurately speaking, is
a physician, whom you now mentioned, whether he is a gainer of
money or one who taketh care of the sick? and speak of him who
is really a physician.

One who taketh care, said he, of the sick.

***********

Why then, said I, no physician as far as he is a physician, con-
siders what is advantageous for the physician, nor enjoins it, but
what is advantageous for the sick; for it hath been agreed that
the accurate physician is one who taketh care of sick bodies, and
not an amasser of wealth. Hath it not been agreed ?

He assented.

(Plato, 428-547 B. C, translated by Spens.)

But Plato 's knowledge of huinan anatomy and physiology
was very crude and in some instances decidedly fanciful.
In corroboration of this statement the following extract
from the * ' Timaeus ' ' may be quoted : —

And on this account, fearing to defile the Divine nature more
than was absolutely necessary, they [the junior gods] lodged man's
mortal portion separately from the Divine, in a different receptacle
of the body; forming the head and breast and placing the neck
between, as an isthmus and limit to separate the two extremes.

In the breast, indeed, and what is called the thorax, they seated
the mortal part of the soul. And as one part of it was naturally
better, and another worse, they formed the cavity of the thorax
into two divisions (resembling the separate dwellings of our men
and women), placing the midriff as a partition between them.
That part of the soul, therefore, which partakes of fortitude and

BEGINNINGS OF A RATIONAL SYSTEM 79

spirit and loves contention they seated nearer the head between
the midriff and the neck ; as it is the business of the reason to unite
with it in forcibly repressing the desires, whenever they will not
obey the mandate and word issuing from the citadel above.

The heart, which is the head and principle of the veins as well
as the fountain of the blood that impetuously circulates through
all the members, they placed in a kind of sentry-house, that, in
case of any outburst of anger, being informed by the reason of any
evil committed in its members, owing either to some foreign cause,
or else internal passions, it (the heart) might transmit through
all its channels the threatenings and exhortations of reason, so
as once more to reduce the body to perfect obedience, and so permit
what is the best within us to maintain supreme command.

But as the gods foreknew, with respect to the palpitation of the
heart under the dread of danger and the excitement of passion,
that all such swellings of the inflamed spirit would be produced
by fire, they formed the lungs to be a sort of protection thereto;
first of all, soft and bloodless, and next internally provided with
cavities perforated like a sponge, in order to cool the breath which
they receive, and give the heart easy respiration and repose in
its excessive heat. On this account, then, they led the channels
of the windpipe into the lungs, which they placed like a soft cushion
round the heart, in order that when anger rises in it to an extreme
height it might fall on some yielding substance, and, so getting
cool, yield cheerfully and with less trouble to the authority of
reason.

(Plato's "Timaeus," translated by Henry Davis.)

Alcmaeon, Empedocles, Diogenes of Apollonia, Anaxa-
goras and Pausanias, whose names are mentioned above
in the list of eminent men who flourished during the golden
age of Greek history, are entitled to further consideration.
Alcmaeon of Crotona was a contemporary and disciple of
Pythagoras. He was specially devoted to the study of
anatomy and physiology, and is credited with the distinc-
tion of having been the first person to dissect animals for
the purpose of learning the formation of the different parts
of their bodies. With the exception of a few fragments
that are to be found scattered throughout ancient medical
literature, Alcmaeon 's writings have all been lost. The
discovery of the optic nerve is credited to him, and

80 GROWTH OF MEDICINE

Neuburger states that he deserves still greater credit for
having been the first to declare that the brain is the central
organ of all intellectual activity.

Of all the disciples of Pythagoras, Empedocles attained
the greatest celebrity. He flourished about 444 B, C, his
residence being at Agrigentum, in Sicily. Much of his
reputation appears to have been due to the mystery which
surrounded many of* his actions. He was even reputed
to have brought again to life persons who were believed
to be dead. His works were all in verse, but only fragments
have come down to us. He placed the seat of hearing in
the labyrinth of the temporal bone. His death occurred
in Peloponnesus at the age of sixty, as the result of an
accident.

Anaxagoras was born at Clazomenae, in Ionia, 500 B. C.
He was the teacher of Euripides, the Athenian poet, and
Pericles, the greatest of Athenian statesmen. He and his
contemporary, Diogenes of Apollonia, in Crete, devoted a
great deal of attention to the study of anatomy. They
dissected animals and made some genuine discoveries;
Anaxagoras noting the existence of the lateral ventricles
of the brain, and Diogenes furnishing a description — ^very
erroneous, it is true — of the vascular system of the body.
Puschmann says that, according to Aristotle, the philoso-
phers of that period considered the study of man and his
diseases the most important one to which they could
devote their time and thoughts. Many of them indeed
had been educated as physicians, and not a few were actual
practitioners of medicine.

CHAPTER VII
HIPPOCRATES THE GREAT

Hippocrates was bom in 460 B. C. in the city of Cos, on
the island of the same name. Both his father and grand-
father were eminent physicians, descendants of Aescu-
lapius. On his mother's side he traced his descent from
Hercules. The famous painter, Apelles, also hailed from
the city of Cos. To distinguish Hippocrates from an
earlier individual of the same name he was called
Hippocrates II., or the Great. He is said to have received
his first instruction in medicine at the school of the
Asclepiadae in his native city, but his frequently repeated
and very favorable comments on the teachings of the
Cnidian schooP have led some to believe that he may have
received a part of his medical training at the latter
institution. At a later period of his life his popularity as
a teacher of medicine, in the school of the Asclepiadae at
Cos, attracted many pupils to that city. In accordance
with a custom which prevailed among the physicians of
ancient Greece, Hippocrate^, at the beginning of his
career, spent quite a long time in Athens, and then traveled
about, from one city to another, in the character of a
periodeutic or itinerant physician. In this way, as he
himself reports in some of his writings, he visited Thessaly,
Thrace, the Island of Thasos, Scythia, the countries
bordering on the Black Sea, and even Northern Egypt.
Owing largely to domestic troubles he left his home in
Cos, during the latter part of his career, and removed
to Thessaly. He died about 370 B. C. at Larissa, at an

1 The city of Cnidus was situated very close to the Island of Cos, on a
peninsula that projects from the coast of Caria, Asia Minor.

82 GROWTH OF MEDICINE

advanced age. Soranus of Ephesus, the celebrated
obstetrician, reported that in his time (second century
A. D.) the tomb of Hippocrates was still standing, and
that it had been taken possession of by a swarm of bees
whose honey was far-famed for its efficacy in curing ulcers
of the mouth in children.

Among the pupils of Hippocrates were his two sons,
Draco and Thessalus, and his son-in-law, Polybus.
Thessalus, in the capacity of a military surgeon, accom-
panied Alcibiades on his expedition to Sicily, and later
in his career he served as private physician to Archelaus,
King of Macedonia. It is also believed that a number of
the writings in the Hippocratic collection are from his
pen. On the other hand, it is a well-established fact that
Polybus is the author of a few of these treatises. When
Hippocrates gave up the work of teaching, his son-in-law,
who was at that time engaged in private practice in Cos,
was chosen his successor in the school.

Among the many anecdotes which are related of Hip-
pocrates, there is one which may with propriety be repeated
here : —

On the occasion of a visit to Abdera, in the northern part of
_ Thrace, Hippocrates was requested to examine into the mental
condition of the philosopher Democritus, who was thought by his
narrow-minded countrymen to be insane. Hippocrates found him
deeply engrossed in the study of natural philosophy and asked him
what he was doing. Democritus replied that he was investigating
the foolishness of men. Whereupon Hippocrates reported that he
considered Democritus the wisest of men. (Pagel.)

No better evidence of the true greatness of a man can be
furnished than that which is afforded by the praise of his
contemporaries in the same rank or walk of life ; and when
the appreciation comes from such men as Plato and
Aristotle, it constitutes an absolute guarantee that it is
well and honestly earned. To Hippocrates belongs the
singular honor of having won unstinted praise from both
of these great philosophers, Aristotle giving him the title
of ''Hippocrates the Great," and Plato comparing him

HIPPOCRATES THE GREAT 83

to those famous sculptors, Polyclytus and Phidias. His
writings and those of the members of his family who were
associated with him in the work of promoting a knowledge
of medicine were most carefully preserved by his successors.
When the Ptolemies began to establish libraries at Alex-
andria, Egypt (285 B. C), and manifested a decided
readiness to purchase the works of the most celebrated
authors, copies of the Hippocratic writings were among
those which found their way to that city. This eagerness
on the part of the Kings of Egypt to purchase books or
manuscripts stimulated unscrupulous persons to attribute
to celebrated authors not a few of these works which they
offered for sale. The librarians, whose duty it was to
guard against such frauds, were not sufficiently well
informed to prevent them; and thus there were accepted,
as genuine productions, a few books which could not
possibly have been written by those to whom they were
attributed. The collectiou of Hippocratic writings did not
escape this fate, and the evil was also further aggravated
by the fact that copyists and incompetent editors made all
sorts of emendations and additions on their own respon-
sibility. Thus, it is not surprising that a collection which
originally contained only the writings of Hippocrates and
his immediate family, should in course of time have become
expanded, not only by such alterations as have just been
described, but also by the addition of entire works that had
been written by others. At the beginning of the third
century B. C, the Ptolemies appointed a committee of
learned men in Alexandria to examine carefully the
treatises reputed to be the work of Hippocrates and to
make a collection of those which appeared to them to be
genuine. They performed this task to the best of their
ability, but the result showed that they lacked the necessary
critical powers; and consequently during the past 2000
years repeated attempts have been made to do what they
failed to accomplish, but these efforts have only succeeded
in part. The French edition prepared by Emile Littre, the
distinguished member of the French Academy of Medicine,
and published in the years 1839-1861, was, until quite

84 GROWTH OF MEDICINE

recently, universally accepted as embodying the best results
of modern research and criticism with regard to this
difficult question. But since 1861 other scholars have been
busily engaged in perfecting the text of the Hippocratic
writings, and their criticisms and suggestions have made
it possible to publish a German version of this great work
which is of more practical value to physicians than that of
Littre, which forms a series of ten large volumes and is
no longer easy to obtain. On the other hand, the German
version by Robert Fuchs (Munich, 1895-1900), in three
volumes of moderate size, while in no respect inferior to
the famous French translation, is superior to it in several
particulars: it is better adapted to the needs of the
ordinary practitioner of medicine, it embodies the results
of the excellent critical work done since 1861 {e.g., by
Ermerins of Utrecht, Daremberg of France, and Ilberg
and Kiihlewein of Germany), and it costs very much less
than its French predecessor and rival.

As regards the question of authenticity of the treatises
contained in the work known as *'The Hippocratic Writ-
ings" the most important thing to be determined is, not
whether this or that book or chapter in the collection was
really written by Hippocrates, but whether the work in
its totality gives a correct and fairly complete picture of
the best medical thought and practice of the period during
which Hippocrates lived; and to this question a decided
answer in the affirmative may be given. As to the broad
question of authenticity. Max Neuburger, the distinguished
Viennese author of the latest and most authoritative
history of medicine, thus expresses himself : —

Notwithstanding the extremely small quantity of evidence which
the so-called ''Hippocratic Writings" themselves furnish as to
who were the writers of the individual treatises and as to what
Hippocrates himself actually did or thought; and although it is
true that portions of the collection often contradict one another
both in regard to questions of theory and also in regard to methods
of treatment, one fact stands out conspicuously, viz., that the
peculiar character of these writings both as a collection and taken
separately, not only gives them a unique position in medical

HIPPOCRATES THE GREAT 85

literature, but reveals plainly that they owe their origin directly
or indirectly to the powerful influence of a single commanding
personality.

As to the manner of teaching medicine, the Hippocratic
writings show that, at the time which is here under con-
sideration, the mystical features had almost completely
disappeared. The science was now taught by regular
instructors, who agreed for a stipulated fee to take charge
of the pupil's entire training from the beginning to the
end of the course. Candidates who were in delicate health
were discouraged from entering upon the career of a
physician, and those who had completed the regular course
of instruction were sent out into the world equipped with
certain general principles for their future guidance in
actual practice. Some of these bear a close resemblance
to the principles of a similar nature which had been
established at a much earlier period in India. For example,
the importance of cleanliness of the person is strongly
emphasized. Reticence, as well as courtesy, is classed as
one of the virtues of a good physician.

He who acts hastily and does not take sufiBcient time for
consideration is sure to be criticised unfavorably. If he breaks
out too readily into laughter he will be thought uncultivated.

In another of the Hippocratic writings the physician is
urged not to indulge in too much small talk, but to confine
his conversation as much as possible to matters relating
to the treatment of the disorder.

In his business dealings the physician, like a genuine philosopher,
should not display a greed for money, he should assume a modest
and dignified attitude, he should appear quiet and calm, and his
speech should be simple and straightforward and free from all
superstition.

For their knowledge of human anatomy the physicians
of that period were obliged to depend on the dissection of
animals. Specimens of human bones were of course easily
accessible, and consequently the descriptions which are

86 GROWTH OF MEDICINE ,

given of these structures are quite accurate, even as
regards many of the finer details.

It would be a very difficult matter to furnish here, within
a limited space, a reasonably clear exposition of the views
held by Hippocrates with regard to human physiology and
pathology. Empedocles, a Greek physician and high priest
of Agrigentum, in Sicily, who was born about 490 B. C,
founded a system of philosophy on the theory that the
universe is made up of four elements — fire, air, earth and
water; and he maintained that fire is the essence of life,
the other elemei^ts forming the basis of matter. It was
upon this system that Hippocrates founded his own theories
of life, death and disease, but he disagreed with Emped-
ocles in regard to the manner in which the four elements
are united, his own belief being that they form together
a genuine mixture, whereas Empedocles maintains that
their union represents merely a mechanical aggregation
of separate atoms. He also held that these original four
elements, to which he gave the names of heat, cold, dryness
and moisture, were represented in the human body by the
following four cardinal fluids or '^ juices": blood, mucus
or phlegm, black bile and yellow bile.^ He maintained,
further, that when these elements are mingled harmo-
niously so as to produce a state of perfect equilibrium,
health resulted; but that when some deficiency of one or
more of them, or some lack of harmony between them in
other respects, occurs, disease is produced. At a later date,
a fifth element — wind or air (pneuma) — ^was added to
the other four; and when Hippocrates was unable to
account satisfactorily for certain phenomena of disease,
he was wont to refer the phenomenon observed to divine
interference.

This brief exposition of the physiological and patho-
logical views held by Hippocrates, incomplete and super-
ficial as it is, mil have to suffice. Those who wish to
acquire a more profound knowledge of the subject should
consult some of the larger treatises like those of Darem-

2 Black bile, it was believed, comes from the spleen, while the yellow variety
is a product of the liver.

HIPPOCRATES THE GREAT 67

berg, of Max Neuburger, and of Pagel, as well as the
sections devoted to these subjects in the French (Littre)
and the German (Fuchs) versions of the Hippocratic
writings. At every step in such a study, the modern
physician will encounter ideas and individual terms which
he will have great difficulty in comprehending; and later
on, as he reads the sections which deal with the more
practical matters of the medical art, he will be astonished
to find that Hippocrates was a most acute and trustworthy
observer of the phenomena of disease, a remarkably clear
writer, and a standard-bearer of very high aims.

In the examination and treatment of the sick the physi-
cians of ancient Greece were highly trained. They paid
very close attention to the patient's account of his
symptoms, but it was to the physical examination of the
diseased body that they attached the greatest importance.
They noted with extreme care the color and other peculiari-
ties of the skin and mucous membranes, the condition of
the abdomen, and the shape and movements of the thorax ;
they tested the patient's temperature by placing the hand
upon the body ; and all the excretions were subjected to the
closest scrutiny. By means of palpation they were able
to determine not only the size of the liver and spleen, but
also the changes which occur in the form of these organs
in the course of certain diseases. They utilized succussion
both as an aid to diagnosis and as a means of favoring the
breaking through of pus into the bronchial tubes. They
were familiar with the pleuritic friction sound and with the
finest rales, which they compared to the • creaking of
leather or ''the noise of boiling vinegar." In their
descriptions of these sounds it is distinctly stated that
the examiner's cartas kept tightly pressed against the
patient's chest. ^

In speaking of the accounts of individual diseases which
appear in the Hippocratic writings, Puschmann says that
they are evidently based 6n cases actually observed in
practice, and that they are admirably written. It is in the
laws which they have laid down with regard to the treat-
ment of disease, however, that the Hippocratic writers have

88 GROWTH OF MEDICINE

gained their chief distinction, a distinction which will
belong to them through all time.

The physician should be the handy man of Nature, and he should
strive to aid and to imitate her efforts to effect a cure. His first
care should be to remove, so far as is possible, the causes of the
disease ; and then, in the conduct of the treatment, he should keep
in view at all times the special circumstances of the case, giving
closer attention to the patient than to the disease itself. In short,
he should aim at being useful, or at least he should be careful not
to do any harm.

1^

CHAPTER VIII

BRIEF EXTRACTS FROM SOME OF THE
HIPPOCRATIC WRITINGS

The statements which have thus far been made in these
pages with regard to Hippocrates are only of a general
character, and it may therefore be interesting for the
reader to have placed before him a few selected extracts
from the writings which have formed the basis of these
statements. The English text here used is a translation
of the German version of Robert Fuchs, to which reference
has already been made. It would have been a pleasure to
use for this purpose the admirable English translation of
Frederick Adams, published in 1849 under the auspices
of the Sydenham Society of Great Britain; but, unfortu-
nately, this version contains only a part of the Hippocratic
writings, and, besides, this writer did not at that time
have the advantage of consulting the French and German
versions which have been published since 1849.

It seems almost unnecessary to state here, by way of
preface, that the small amount of space which may properly
be devoted to these extracts renders it necessary to present
many of them in a very fragmentary and disconnected
form, merely enough text being furnished to give the
reader some slight idea both of the manner in which
Hippocrates and those associated with him handled certain
medical topics, and also of the views which they entertained
with regard to the same subjects.

BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS

Aphorisms. — I. — 1. Life is short, art is long, the right moment
lasts but an instant,^ experience is often deceptive, a correct
judgment is hard to reach.

1 Daremberg (Hist, de la Mid.) makes the following comments on this

90 GROWTH OF MEDICINE

6. For the most serious ills extreme measures cautiously-
employed are the best.

8. When an illness has reached its acme the lightest diet must
be prescribed.

11. During the exacerbations nourishment should be withheld,
for at these times the giving of food is harmful; and in illnesses
which are characterized by periodic paroxysms it is also best not
to give food during the paroxysms.

13. Old people bear fasting very well, and the same is almost
true of persons of mature age ; but young individuals do not bear
abstinence from food so well, and this is particularly the case with
children, especially with those of a lively disposition.

24. In acute illnesses laxative remedies should rarelv be admin-
istered, and then only in the early stage of the malady and with
great caution.

II. — 2. When sleep puts an end to delirium it is a good sign.
3. When either sleep or wakefulness oversteps the proper
limit it is harmful.

5. Causeless depression is an indication of some disorder.

19. In acute diseases the prognosis as regards either death or
recovery, is very uncertain.

44. Corpulent persons are more likely than those who are
slender to die a quick death.

V. — 7. When epileptic attacks occur before the age of puberty,
a change for the better may be looked for ; but if the disease makes
its first appearance when the individual has already reached his
twenty-fifth year, he may be expected to carry the affliction with
him to the time of his death.

9. Consumption most commonly attacks persons who are
between the ages of eighteen and thirty-five.

14. When a consumptive person has attacks of diarrhoea, a
fatal issue may be anticipated.

VII. — 1. If in the course of an acute illness the extremities
grow cold, it is an unfavorable sign.

sentence: "How many are the occasions when we physicians would have it
in our power to avert death, or at least to postpone it for a few hours, if we
would only engrave upon our memories these words of the old man of Cos I
'What a cruel responsibility rests upon those whose duty it is to summon the
doctor at the proper moment! And how great must be the remorse if he fails
to arrive in time ! ' On the other hand, how wise is the remark of Celsus :
'The best practitioner is he who never loses sight of his patients.' "

EXTRACTS FROM HIPPOCRATIC WRITINGS 91

14. If, after a blow upon the head, stupefaction or delirium
manifests itself, the outlook is bad.

[The total number of the aphorisms is 422.]

The Book of Prognoses. — 1. I believe that it is best for a
physician to acquire a certain degree of practice in the power to
predict how the disease is likely to terminate ; for if, when he is in
-the presence of his patient, he is able to state, not only what is
going to take place in the future course of the malady, but also
certain other facts which relate to the past behavior of the attack,
but which were omitted from the account given to him of the
previous history of the case, he will impress the patient with the
belief that he is thoroughly familiar with the disease from which
the latter is suffering, and that consequently he is a physician
in whose knowledge and skill he can place entire confidence. Then,
besides, he will be the gainer in another respect: his knowledge
of what is likely to be the subsequent course of any given disease
will enable him to treat it in the most effective manner. The
ability to restore all his patients to health would of course be a
greater power than that of correctly predicting the future behavior
of a malady in any particular case. This ability, however, is clearly
unattainable. One patient dies by reason of the severity of the
disease itself, even before the physician is called in; a second one,
shortly after the latter 's visit; and a third lingers on for a day
or two after the doctor's arrival, dying before the latter 's art has
had time to produce a beneficial effect in hindering the advance
of the malady. The observation of these different events should
enable the physician to become acquainted with the nature of the
diseases observed, and — more particularly — to learn to what extent,
in individual instances, they manifest a strength greater than the
patient's power of resistance. At the same time, he must not
forget that in many cases divine interference plays a part in
directing the course of the disease. And thus, if he pays heed to
all these things, the physician will merit the confidence of his
patients and will gain the reputation of being a clever and skilful
practitioner.

IV. — It is better when the physician, upon the occasion of his
first visit, finds the patient lying upon one side, with his hands,
neck and thighs slightly flexed, and the entire body placed in a
perfectly natural position, like that which a man assumes in bed
when he is in a state of health. It is not so well when the physician
finds the patient lying upon his back, with his hands, neck and

92 GROWTH OF MEDICINE

thighs extended. But if the latter is found curled up and sliding
down toward the foot of the bed, this is an unfavorable sign.
Finally, if he is found with rather cold feet projecting from under
the bedclothes, and with his arms outstretched and his neck and
thighs exposed, his condition may be considered dangerous, for
this attitude of the body betokens an agitated state of the mind.
If the patient sleeps with his mouth constantly open, lying upon
his back and with his thighs strongly flexed and widely separated,
it may be assumed that death is near at hand. If he lies upon
his belly when it is known that he was not in the habit of sleeping
in this manner before he was taken ill, the inference is warranted
either that he is delirious or that he is suffering from pain in the
lower part of his abdomen. Finally, if the patient shows an
inclination to maintain a sitting posture while the malady is still
in an active stage, this feature must be looked upon as a grave
symptom and especially so in inflammation of the lungs.

XIV. — Pus that has a whitish color and a uniform consistency,
that is smooth and free from clumps, and the odor of which is only
slightly unpleasant, is the least harmful. On the other hand, a
pus which possesses the opposite characteristics is very dangerous.

XL. — Severe pain in the ear, if associated with a persistent
fever is dangerous, for the patient may become delirious and die.

[There are 47 chapters in the Book of Prognoses; in
addition, there are 740 separate sections in the Coan
Prognoses {Praenotiones Coacae).]

The Epidemic Diseases. — ^VI. — 4. The wife of Agasis had
already as a young girl been troubled with shortness of breath.
After she had reached womanhood, and soon after she had given
birth to a child, she lifted a heavy weight. Immediately she heard,
as she believed, a noise in her chest, and on the following day she
experienced some difficulty in breathing and a certain amount of
pain in her right hip. These two symptoms were so related to
each other that, whenever the pain in the hip made its appearance,
she immediately became conscious that she was short of breath,
and, vice versa, whenever the pain ceased, she found that her
breathing became easier. Her expectoration was of a foamy
character and of a rather bright color, but, after it had been
allowed to stand for a short time, it looked like diluted biliary
matter that had been vomited. The pain in the hip troubled her
chiefly when she performed manual work. She was advised to

EXTRACTS FROM HIPPOCRATIC WRITINGS 93

abstain from eating garlic, pork, mutton, and beef, and not to
call loudly or to get excited while she was engaged in work.

VII. — 7. The wife of Polycrates became feverish during the
summer season, and about the time of the dog star. In the morning
her breathing was somewhat embarrassed, but after mid-day it
became more difficult and at the same time more rapid. From
the very beginning of the illness she had a cough and expectorated
purulent masses. In the throat and along the course of the trachea
one could hear a hoarse whistling sound. The patient's face had
a healthy color, and over the two halves of the jaw there was some
redness, not of a deep hue but rather fresh and bright. A little
later her voice also became hoarse, she began to show some
emaciation, raw spots developed over the fleshy parts of her hips,
and the surface of the body grew more moist than it had been
before. On the seventieth day the outward evidences of fever
became much less noticeable, but the respiration grew more rapid ;
and from that day to the time of her death, five or six days later,
she was obliged to remain in a sitting posture. Toward the end
the tracheal rale grew louder, and dangerous sweats occurred, but
the patient never lost her expression of intelligence.

Fractures. — II. — 9. In the human body the foot, like the hand,
is composed of a number of small bones. As they are not easily
broken it may safely be assumed, when such a case of fracture
comes under observation, that some pointed or unusually heavy
object had caused the lesion, and that the surrounding soft parts
must necessarily have been injured at the same time. (Injuries
of this nature will be discussed in a later section.) But if any
part of this bony framework is pushed out of its natural position —
whether this take place in one of the toes, or in one of the tarsal
bones, it makes no difference — the dislocated part should be forced
back into position in the manner recommended in section XXIV.
In its essential features the treatment consists in the employment
of wax plaster, compresses, and bandages, exactly the same as is
done in the treatment of fractures of the long bones, but without
splints. The same rules hold good with regard to the degree of
pressure to be applied, and every third day the dressings should
be renewed. On each occasion of such renewal the patient should
be questioned with regard to the sensations which he feels after
the bandages have been applied, and if necessary they should be
readjusted in accordance with the nature of the answers which
he gives. The great majority of these injuries heal completely in
twenty days. The exceptional cases are those in which the fracture

94 GROWTH OF MEDICINE

involves a bone that stands in immediate relation with the bones
of the leg. It is advisable, however, that the patient should remain
in bed during the period mentioned; for, in not a few instances,
the persons thus affected, failing to appreciate the gravity of the
injury, walk about before the parts have really healed; and then,
for an indefinite period of time, they are frequently reminded in
a painful manner of the injury which they received. There is
nothing astonishing in this when the fact is recalled to mind that
the feet support the entire weight of the body.

[Forty-eight chapters or sections, some of them of
considerable length, are devoted to the subject of fractures.
The authorities are almost unanimous in stating that this
portion of the so-called Hippocratic writings was written
by Hippocrates himself. Malgaigne and Petrequin, two of
the most competent French writers on questions relating
to surgery, declare that the treatises written by Hip-
pocrates on fractures and dislocations (the two forming
in reality one continuous treatise) are the best and most
complete books ever written by a physician.]

Wounds of the Head. — 10. The physician should, first of all,
before touching the patient's head, inspect carefully the wound
and surrounding parts. After noting whether the injury has been
inflicted upon a strong or a weak portion of the head, he should
ascertain whether the hair has been cut by the fall or the blow,
and whether portions of it have penetrated into the wound. In
the latter event he should express his fear that the skull at this
point has been laid bare and has perhaps even received some
material injury. He should make this statement before he has
touched or probed the wound. Then afterward he should proceed
to a physical examination of the injured parts, in order that he
may learn positively whether the overlying soft tissues have or
have not been separated from the bone. If simple inspection
reveals the fact that the skull has been laid bare, well and good;
but, if the real condition is not thus revealed, he should not hesitate
to employ the probe. If he finds that the soft parts have been
separated from the bone and that the latter has been more or less
injured, he should continue this more minute exploration until
he shall have ascertained to just what extent and in what manner
the skull has been injured, and what measures are required to
remedy the damage ; in brief, he should make the diagnosis. At the

EXTRACTS FROM HIPPOCRATIC WRITINGS 95

same time, however, he should not neglect to question the patient
very closely about the manner in which the wound was inflicted,
for in this way he may be able to infer the existence of a contusion,
or even a fracture of the skull, of which no material evidences are
discoverable. Important information may also be gathered by
passing the hand over the seat of injury in the bone, — information
which the employment of the probe is not competent to convey,

[Twenty-one additional chapters are devoted to wounds
of the head, every possible phase of the subject being
handled by Hippocrates in the most careful and thorough
manner.]

CHAPTER IX

THE STATE OF GREEK MEDICINE AFTER THE
EVENTS OF THE PELOPONNESIAN WAR; THE
FOUNDING OF ALEXANDRIA IN EGYPT, AT
THE MOUTH OF THE NILE ; AND THE DEVELOP-
MENT OF DIFFERENT SECTS IN MEDICINE

Up to the time when war broke out between Sparta and
Athens (431 B. C), the latter city had for many years
easily held the supremacy, not merely in everything
relating to the science and art of medicine, but also in all
other branches of learning and especially in the arts of
sculpture, painting and architecture. At the time named
above came the beginning of her downfall. For a period
of about twenty-one years she struggled against disasters
of all sorts.

The Plague at Athens, the first Recorded in History. —
Shortly after the war began — a war engendered by the
bitter jealousy of Sparta over the ever increasing ascend-
ancy of her rival — the latter city was visited by a devas-
tating plague, the first European pestilence that has been
recorded in history. Thucydides, who wrote the history
of the Peloponnesian War, gives a most lucid description
of this plague of Athens, from which I shall copy certain
portions.

It first began, it is said, in the parts of Ethiopia above Egypt,
and thence descended into Egypt and Libya and into most of the
King's country. Suddenly falling upon Athens, it first attacked
the population in Piraeus, — which was the occasion of their saying
that the Peloponnesians had poisoned the reservoirs, there being
as yet no wells there, — and afterward appeared in the upper
city, when the deaths became much more frequent. All speculation

DEVELOPMENT OF SECTS IN MEDICINE 97

as to its origin and its causes, if causes can be found adequate to
produce so great a disturbance, I leave to other writers, whether
lay or professional ; for myself, I shall simply set down its nature,
and explain the symptoms by which perhaps it may be recognized
by the student, if it should ever break out again. This I can the
better do, as I had the disease myself, and watched its operation

in the case of others People in good health were all of a

sudden attacked by violent heats in the head and redness and
inflammation in the eyes, the inward parts, such as the throat or
tongue, becoming bloody and emitting an unnatural and fetid
breath. These symptoms were followed by sneezing and hoarse-
ness, after which the pain soon reached the chest, and produced
a hard cough. When it fixed in the stomach, it upset it; and
discharges of bile of every kind named by physicians ensued,
accompanied by very great distress. In most cases, also, an
ineffectual retching followed, producing violent spasms, which in
some cases ceased soon after, in others much later. Externally
the body was not very hot to the touch, nor pale in its appearance,
but reddish, livid, and breaking out into small pustules and ulcers.
But internally it burned so that the patient could not bear to have
on him clothing or linen even of the very lightest description;
or indeed to be otherwise than stark naked. What they would
have liked best would have been to throw themselves into cold
water; as indeed was done by some of the neglected sick, who
plunged into the rain-tanks in their agonies of unquenchable
thirst; though it made no difference whether they drank little or
much. Besides this, the miserable feeling of not being able to rest
or sleep never ceased to torment them. The body meanwhile did
not waste away so long as the distemper was at its height, but held
out to a marvel against its ravages; so that when they succumbed,
as in most cases, on the seventh or eighth day to the internal
inflammation, they had still some strength in them. But if they
passed this stage, and the disease descended further into the
bowels, inducing a violent ulceration there accompanied by severe
diarrhoea, this brought on a weakness which was generally fatal.
For the disorder first settled in the head, ran its course from
thence through the whole of the body, and, even where it did not

prove mortal, it still left its mark on the extremities;

some, too, escaped with the loss of their eyes Some died

in neglect, others in the midst of every attention. No remedy was
found that could be used as a specific; for what did good in one
case, did harm in another Such was the nature of the

98 GROWTH OF MEDICINE

calamity, and heavily did it weigh on the Athenians ; death raging
within the city and devastation without.

(Translation of Richard Crawley; Dent & Sons, London.)

Athens Ceases to be the Centre of Medical Learning. —
It is safe to assume that one by one the more prominent
of the physicians who had survived the events which have
just been narrated, must have left Athens and taken up
their abode in the various cities of Asia Minor and the
neighboring islands, in Sicily, in Italy, etc. Hippocrates,
who was thirty years old at the time when the plague broke
out in Athens, appears not to have witnessed it. He
practiced his profession and taught medicine in his native
city; then he spent a certain number of years in traveling
about as a peripatetic physician; and finally settled for
the remainder of his life in Thessaly. But the length of
each of these periods of his professional life is not men-
tioned by any of the authorities. About forty years after
the death of Hippocrates, Alexander the Great had already
nearly completed his series of brilliant conquests, and was
taking steps to found a city, or rather, a university, in
which medicine was to take an organized shape as one of
the great departments of human learning.

It may be well at this point, however, to interrupt this
narrative of the regular course of events for the purpose
of considering very briefly how far the physicians of that
period had advanced toward gaining a permanent and
honorable position in their respective communities.

The Degree of Esteem in which Physicians Were Held by
Their Fellow Citizens and by the Governing Authorities
During the Centuries Immediately Preceding the Christian
Era, — ^We have at our command very little direct evidence
bearing upon the question of the esteem in which physicians
were held three hundred years B. C. by the communities
in which they practiced their profession. We know posi-
tively that the kings and princes of that period fully
appreciated the value of the services which were rendered
to them by the physicians (commonly Greeks) whom they
employed. In the event of war they took with them men
who were skilled both in surgery and in the treatment of

DEVELOPMENT OF SECTS IN MEDICINE 99

the ordinary ills of the body. One of the sons of Hip-
pocrates, for example, served for some time in this
capacity, and he is credited with the statement that *'the
physician who wishes to obtain the best training in
surgery should enter the service of the army." There
were eight surgeons officially connected with the **ten
thousand" whom Xenophon led back to Greece after the
famous campaign in Asia Minor. The army of Alexander
the Great was accompanied by the most celebrated surgeons
of that period. Upon a bronze tablet found at Idalium,
on the Island of Cyprus, there is an inscription which dates
back to the fifth century B. C, and which commemorates
the merits of a physician named Onasilos, who, aided by
his pupils, rendered valuable services, without any remu-
neration, during one of the wars of the Greeks; and in
recognition of these services, the Government had bestowed
upon him a stipend and had exempted him from taxation.
It is further known that the Athenians lavishly heaped
honors upon Hippocrates, initiating him at public expense
into the mysteries of the Eleusinia, giving him a crown of
gold, and distinguishing him in still other ways. These
facts show how highly the rulers of that day appreciated
the services of a competent physician; but, up to a com-
paratively recent date, it has not been so easy to demon-
strate what was his position in the esteem of the community
at large. The discovery, not many years ago, of two
inscriptions in Greek throw a certain amount of light upon
this very point. One of these, which bears the date of
388 B. C., states that its purpose is to commemorate the
fact that the physician Euenor, who had been intrusted
by the people with the work of supervising the preparation
of all the drugs intended for use in the public hospital,
had not only fulfilled his duty but had in addition spent
large sums of his own money in the accomplishment of
this work. Another inscription, which was unearthed in
the Island of Carpathus, between Crete and Rhodes, and
which is believed to date back to the end of the fourth or
the beginning of the third century B. C, reads (in a some-
what abbreviated form) as follows: **In view of the fact

100 GROWTH OF MEDICINE

that, for more than twenty years, Menocritus, the son of
Metrodorus of Samos, has devoted himself with much zeal
and self-sacrifice to the duties of his position as parish
physician, living all this time in rather narrow circum-
stances and not asking any pay for his services, we, the
citizens of Brycontium, have resolved to erect in his honor,
in the temple of Neptune, a marble column bearing an
inscription that shall set forth these facts, to crown him
with a wreath of gold, and to announce publicly, at the
Aesculapian games, this our decision." As apropos of
this subject I may be permitted to quote the following
words from Plato's **The Republic" (Book 1, Chap. 18) :
''Will you call the medicinal the mercenary art, if, in
performing a cure, one earns a reward? No, said he."

The Founding of Alexandria. — ^Alexander the Great,
after subduing the Persians and the cities of Phoenicia,
marched into Egypt and founded (331 B. C), at the mouth
of the Nile, the city of Alexandria, In October of the same
year he crossed the Euphrates and the Tigris and defeated,
for the second time, the Persian hosts under Darius.
Alexander was now the conqueror of Asia. During the
following eight years he laid his plans most carefully for
the consolidation of his great empire, the capital of which
was to have been Babylon; but, while he was thus making
provision for the welfare of his numerous subjects, who
were of widely different tastes and aspirations, he suc-
cumbed (323 B. C.) to a severe attack of malarial fever,
aggravated by an excessive indulgence in wine on the
occasion of some festivity. In the meantime Alexandria
was developing rapidly into a great centre of learning in
all the departments of human knowledge. The Ptolemies,
beginning with Ptolemy Soter, who reigned over Egypt
from 323 to 285 B. C, contributed greatly to this result.
For a period of about 250 years Alexandria remained the
centre around which revolved all that was best in the
domains of medicine, philosophy, geometry, mathematics,
history, etc. Money was spent lavishly in collecting the
writings of all those authors who had distinguished them-
selves in these different fields of learning, and no pains

BEVELOPMENT OF SECTS IN MEDICINE 101

were spared to secure correct versions of the different
works; the septuagint version of the books of the Old
Testament of the Bible being a conspicuous example of
what the Ptolemies accomplished in this direction during
the third century B. C. Every possible facility was offered
at the same time for the giving and receiving of instruction ;
and thus, with the immense library as a foundation of
priceless value, the Museum at Alexandria became in every
material respect a great university, the first one of which
history gives us any fairly satisfactory information.
Several years after the Museum library was established
a second one of somewhat smaller proportions was
organized in the Serapeum (Temple of Serapis). The
example set by the Ptolemies was followed by Attains,
King of Pergamum in Mysia, Asia Minor (241 B. C), and,
before many years had elapsed, the great library of that
city almost rivaled those of the Museum and Serapeum
at Alexandria. It was the competition between these two
royal collectors of books that led to the issuing of a decree
that no more papyrus was to be exported from Egypt, and
thus there was provided the stimulus which led to the
discovery or invention of a new and better material on
which books might be written — viz., Pergamentum (our
parchment), a word coined from the name of the city in
which it was invented.

The Development of Different Sects or Schools of
Medicine. — Up to the time of the death of Hippocrates
medicine maintained the character of a single organized
and harmonious body; but, when this great physician had
disappeared from the scene and was no longer there to
guide the further development of medical science and to
keep his followers working shoulder to shoulder with a
single spirit and purpose, this hitherto homogeneous body
split up into sects or schools, each of which had some
favorite doctrine the promulgation of which seemed to
each group of adherents to be of great importance. There
were at first two such principal groups, viz., the Dogmatics
and the Empirics. The former was composed of those who
laid great stress upon speculation or theorizing, — that is,

102 GROWTH OF MEDICINE

upon the use of the reasoning power, — and the latter of
men who maintained that actual experience was the only-
thing of any serious value. The respective leaders of
these two groups or sects were Plato and Aristotle.

In Raphael's celebrated painting, ''The School of
Athens," these two heroes of philosophy are represented
standing side by side — Plato with his right hand elevated
and pointing toward heaven, while Aristotle is looking
distinctly at the earth. Pictorially, the tendencies of the
two schools of philosophy could not have been better
represented. Plato's genius had taken its flight heaven-
ward and was contemplating earthly things from this point
of vantage ; his method being to ignore system and to look
at everything with the eyes of purest love. ''Delightfully
poetic, but thoroughly unprofitable speculation as to
what constitutes scientific truth and perfected morality!"
(Friedlaender.)

Aristotle, whose father was a physician and a descendant
of Aesculapius, was the hero and guiding spirit of those
who based their philosophy on experience, on ascertained
facts. Like his celebrated pupil, Alexander the Great, who
brought whole nations under his sway, he too was a
conqueror in every field of human knowledge. His ideas
ruled supreme over the minds of men for thousands of
years and to-day, although many of them are no longer
accepted as valid, Aristotle himself is universally held to
have been the greatest thinker and investigator who has
ever lived upon this earth. (In chapter XIII, I shall have
occasion to say something further regarding the Dogmatics
and the Empirics.)

Out of the teachings of Plato and Aristotle developed
two schools of philosophy that exerted, in course of time,
a great influence upon the minds of men and upon the
growth of medical science. The schools referred to are the
Epicureans and the Stoics. Epicurus (242-270 B. C), who
gave his name to the first of these, taught that the highest
good was happiness.

The happiness he taught his followers to seek was not sensual
enjoyment, but peace of mind as the result of the cultivation of

DEVELOPMENT OF SECTS IN MEDICINE 103

all the virtues. According to the teaching of his school virtue
should be practiced because it leads to happiness; whereas the
Stoics taught that virtue should be cultivated for her own sake,
irrespective of the happiness it will ensure. Zeno (circa 370-260
B. C), the founder of the Stoic philosophy, taught an ethical
system according to which virtue consists in absolute judgment,
absolute mastery of desire, absolute control of the soul over pain,
and absolute justice. The kejmote of the system is duty, as that
of Epicureanism is pleasure. (Sir "William Smith.)

In addition to the sects named above, there was still
another known as the Older Dogmatic School, which was
composed of men who had been the direct followers of the
great master, but who, forgetting altogether the practical
teachings of Hippocrates with regard to the importance
of experience, gave themselves up to all sorts of hypotheses
and theories. Among the names of the earliest followers
of this school one is astonished to find those of Thessalus
and Draco, the sons of Hippocrates, as well as the name
of Polybus, the latter 's son-in-law. Diodes of Carystos
and Praxagoras of Cos, two of the most distinguished
men of that period, were also among the earliest members
of this dogmatic school. Diodes, who was one of the
Asclepiadae, owed his celebrity in part to his contributions
to our knowledge of anatomy and in part to the work which
he had done in other departments of medicine. Unfortu-
nately, all of these writings have been lost with the
exception of a few fragments which came to light toward
the middle of the nineteenth century. Praxagoras was also
one of the Asclepiadae. He was distinguished, as has
already been stated on an earlier page, by the fact that
he — and not Aristotle, as is sometimes stated — was first
to recognize the difference between arteries and veins, and
also by the further fact that he called attention to the
practical value of the pulse as an indication, in certain
diseases, of the tone of the patient's bodily condition or
vitality.

CHAPTER X

ERASISTRATUS AND HEROPHILUS, THE TWO
GREAT LEADERS IN MEDICINE AT ALEX-
ANDRIA; THE FOUNDING OF NEW SECTS

Two of the most celebrated physicians of that period
(305-280 B. C.) were Erasistratus and Herophilus, both
of whom were distinguished as the founders of schools or
sects of medicine at Alexandria. They had received their
early training as physicians from Chrysippus, a widely
known Stoic philosopher, who, according to Albert von
Haller, had taught at the school of Cnidus and had also
written on medical topics ; and, among the other teachers,
it is stated that Anaxagoras of Cos had instructed
Herophilus, and that Metrodorus, the son-in-law of Aris-
totle, had performed the same service for Erasistratus.
So far as fundamental principles are concerned, the schools
founded by these two physicians at Alexandria differed
very little from each other, and the men themselves also
gained their distinction in very much the same branches
of medical knowledge, both of them having made a number
of original discoveries in anatomy and both of them having
become eminent practitioners.

Herophilus was born at Chalcedon, a Greek city on the
Propontus, nearly opposite to Byzantium. We possess no
knowledge whatever regarding the earlier years of his
career, notwithstanding the fact that no fewer than four
different men devoted their energies to the writing of his
biography. The books themselves have been either lost
or destroyed. Herophilus showed a decided leaning toward
the study of anatomy, and his contributions to this branch
of medicine are among the earliest which we possess.

ERA8ISTRATUS AND HEROPHILUS 105

I'erophilus strove to supply one of the most conspicuous
;ficiencies in the Hippocratic system of medicine, viz.,
inadequate knowledge of the nervous system; and to this
end he conducted a series of the most careful investigations,
as a result of which he was successful in establishing
several facts previously unknown. He described the mem-
branes of the brain, the choroid plexus, the venous sinuses,
the structure which bears his name, — the torcular Hero-
phili, — the cerebral ventricles, and the calamus scriptorius ;
he traced the course of the nerve trunks for some distance
from their origin in the brain and spinal cord ; and it was
he who established the fact that two different sets of nerves
exist — one for conveying sensations to the brain and the
other for producing motion. In addition, he investigated
the corpus vitreum, the retina, the optic nerve, etc. He also
called attention to the peculiar mode of construction of
the duodenum, and to the fact that the walls of the arteries
are thicker than those of the veins. Some idea of the
accurate manner in which he carried on his anatomical
researches may be gained from the fact that he noted the
circumstance that the left vena spermatica occasionally
originates in the vena renalis.

Herophilus also gained distinction in the practical
branches of medicine. According to Puschmann he laid
the foundations for a scientific sphygmography. Thus he
distinguished several varieties of pulse in accordance with
the differences which he noted in its strength, regularity,
degree of fulness, and rate of speed. He also must have
had considerable experience in surgery, as is shown by his
remark that a dislocation of the thigh, owing to the tearing
of the ligamentum teres which necessarily accompanies
such a dislocation, is likely to occur again in the same
individual. In his writings relating to the practice of
medicine, Herophilus upheld the principle that experience
alone should be our guide, as theoretical considerations are
not to be trusted. He is also credited with having said, in
response to the question. Whom do you consider the best
physician? "Him who knows how to distinguish what is
attainable from what is unattainable. ' '

106 GROWTH OF MEDICINE

Erasistratus, the contemporary of HeropMlus and his
associate in the work of establishing at Alexandria a great
anatomical and clinical medical school, was a native of
Julis, in the Island of Ceos, not far from the coast of
Attica. In the earlier part of his professional career he
spent some time at the Court of Seleucus, the founder of
the Syrian monarchy (312-280 B. C). This monarch, who
had been one of Alexander the Great's distinguished
generals, consigned the government of the eastern part
of his vast kingdom to his son Antiochus. The latter fell
ill about this time, and the most distinguished physicians
of the Court were then called in to determine what was the
nature of his malady and to decide upon the proper treat-
ment. The patient grew more and more languid, showed
complete indifference to all that took place about him, and
steadily lost flesh. Erasistratus, who was one of the
physicians summoned, observed his behavior very closely
and soon noted the fact that, whenever Stratonice, his
young and attractive stepmother, entered the sick room,
Antiochus became agitated ; his face being flushed, his voice
subdued, his pulse more rapid, and his eyes brighter, all
of which signs of excitement disappeared when Stratonice
left the room. From these phenomena this shrewd observer
drew the inference that the patient was deeply but hope-
lessly in love with his father's second wife. Accordingly
he informed Seleucus that his son's illness was simply the
result of having lost his heart to one who was unable to
return his affection. Seleucus, who was much astonished,
asked with deep interest who was the lady. ''My wife,'*
replied Erasistratus, without an instant's hesitation. ''But
tell me then," asked Seleucus, "would you be willing to
cause the death of my son, who is so very dear to me, by
refusing to give up your wife to him?" "Would you,
yourself, my lord, under similar circumstances," replied
the physician, "be willing to give up Stratonice to the
Prince, if it had been she with whom he had fallen in love ? ' '
Seleucus having already vowed that he would not hesitate
for a moment to do so, Erasistratus declared the whole
truth to him, and of course there was nothing left for the

ERASISTRATU8 AND HEROPHILUS 107

King but to keep his word. History fails to state whether
or not the lady made any objection to the transfer. As
Antiochus lived to reign for many years after the murder
of his father, it is safe to assume that he recovered his
health.

This brief tale, the truth of which is not disputed by any
of the authorities, reveals Erasistratus to have been a
clever diagnostician, to have possessed a profound knowl-
edge of human nature, and to have been a man of excep-
tional courage; in short, he was a physician admirably
fitted to act as the founder and leader of one of the two
great medical schools of Alexandria. The following
account may suffice to convey some idea of his career after
he became established at the latter city.

At the beginning of his residence in Alexandria,
Erasistratus, like his great rival Herophilus, devoted his
energies to anatomical and physiological researches.
These two men evidently realized to the full how important
it was to medicine, if it were to make a substantial advance
beyond the point to which Hippocrates and his followers
had already carried it, that a more complete understanding
of the structure and working of the human body should be
obtained; and their efforts in this direction were greatly
aided by the enlightened views of the kings of Egypt, the
Ptolemies, who did everything in their power to furnish
these two investigators with all the human dissecting
material they could use to advantage. They even went so
far as to allow them the privilege of utilizing, for scientific
purposes, the living bodies of imprisoned criminals, ''in
order that they might in this way learn the location, color,
shape, size, construction, hardness, softness, smoothness,
nature of external surface, protuberances and recesses of
the individual organs during life." The defense which
they offered for permitting such vivisections was this:
"It is permissible to sacrifice the lives of a few criminals
if many worthy persons may thereby be permanently
benefited in health, or have their lives prolonged."
(Puschmann.) Those who were opposed to such exami-
nations upon human beings expressed their disapproval in

108 GROWTH OF MEDICINE

the following terms: **TMs practice is not only cruel, but
useless, and at the same time it derogates from the dignity
of the healing art, which is intended to be a blessing and
not a source of pain to man; for those in whom the
abdominal cavity is first opened and then the diaphragm
divided, die before it is possible to make the scientific
examination ' during life ' which constitutes, as it is claimed,
the justification for the entire procedure." (Puschmann.)
As regards the work done by Erasistratus in the depart-
ments of anatomy and physiology, the following statement
may be made: He threw a great deal of additional light
upon the structure of the lacteals, the valves of the heart,
the brain, the nerves, and several other portions of the
body ; and he assigned to the pneuma, or breath,^of which
he assumed that two kinds exist, — the most important role
in the mechanism of life. According to the description
given by Galen and reported by Le Clerc, the phenomena
to which Erasistratus refers take place somewhat as
follows: ''When the thorax or chest expands, the lungs
also undergo dilatation and fill themselves with air. This
air, entering first by way of the trachea, ultimately reaches
the anastomosing terminals of the bronchial tubes, from
which locality the heart, by the act of dilatation, draws it
into itself, and then, immediately afterward contracting,
sends it, by way of the great artery (the Aorta), to every
part of the body." When it is considered that at this
remote period of time nothing was known about oxygen
and carbon dioxide, nor about the power of these elements
to pass freely through a thin membrane (exosmosis and
endosmosis), no surprise will be felt that Erasistratus
carried the physiology of respiration no farther than he
did. On the contrary, it is remarkable that he was able to
describe so correctly this complicated process. In fact,
none of his successors, up to the time when Harvey's great
discovery was announced, was able to furnish a better
description. The physiology of gastric digestion was
another of the problems concerning which Erasistratus
held views that were different from those commonly
accepted by the physicians of that time. The stomach, he

ERASISTRATUS AND HEROPHILUS 109

maintained, first retracts when portions of food are
introduced and then contracts in such a manner as to break
them up into smaller and smaller fragments ; this process
taking the place of that of *'coction," as taught by Hip-
pocrates. The resulting chyle passes from the stomach
into the liver and is deposited in those spots where the
finer branches of the vena cava and the terminal twigs of
the channels which lead into the gall-bladder come together.
Here the chyle breaks up into two portions, one of which —
viz., that which contains biliary elements — gains an
entrance into the channels that lead to the gall-bladder,
while the other, which is composed of elements suitable
for making pure blood, finds its way into the ramifications
of the vena cava. While holding these views about the
mode of transformation of gastric chyle into the bile and
pure blood, Erasistratus did not hesitate to confess that
he was unable to say whether bile was produced within
the body or whether it already existed in the food that was
taken into the stomach.

As regards the treatment of disease Erasistratus held
certain views which were decidedly at variance with those
maintained by the majority of his associates. Thus, for
example, Straton, a distinguished disciple of this master,
praises him for having banished bloodletting from the list
of remedial measures, and adds that he can testify to the
fact that Erasistratus had, by other means, cured all the
diseases in which the ancients commonly employed blood-
letting as the chief remedial agent. His favorite substitutes
for the latter procedure were fasting, dieting, physical
exercise, and — in cases of hemorrhage — placing ligatures
around the arms and legs. Caelius Aurelianus is authority
for the statement that, in certain very exceptional cases,
Erasistratus did resort to bloodletting. Another of the
latter 's tenets was his strong objection to the employment
of purgatives and composite remedies. On the other hand,
he appears to have attached considerable importance to
the employment of chicory in the treatment of all disorders
of the abdominal organs. One of the eividences of his
preference for this drug is to be found in the care which

no GROWTH OF MEDICINE

he takes in describing how the plant should be prepared for
remedial purposes. "Boil a bunch of the plant in water
until the mass is thoroughly cooked; then cast it into a
fresh supply of boiling water (to drive out still more of its
bitter quality) ; and finally, upon removing it from the
boiling water, place it for conservation in a receptacle
containing oil. When it is required for use add a small
quantity of weak vinegar. ' ' Galen, in commenting jocosely
upon the stress which Erasistratus lays upon these details,
makes the remark: ''As if our domestics did not know
how to cook a bunch of chicory ! ' '

Speaking of the effects produced by venom when one is
bitten by a poisonous snake, Erasistratus remarks that
''from the effects which the poison introduced in this
manner produces, we may derive a general indication as
to how a cure may be obtained. The poison, it will be noted,
destroys very quickly the parts with which it comes in
contact, and then, by spreading throughout the body,
causes death. The thing to do, therefore, is to draw it as
quickly as possible out of the body and thus arrest its
further spread. To this end the wound should first be
enlarged and its sides scarified; then, after it has been
sucked, a cupping glass should be applied over it; and,
finally, it should be cauterized."

Erasistratus cultivated surgery as well as the other
branches of medicine. He was a bold operator, as may be
inferred from the fact that, in cases of scirrhus or other
variety of tumor of the liver, he did not hesitate to incise
the skin and overlying integuments, and then, after the
peritoneal cavity had been opened, to apply directly to the
seat of the disease such medicaments as seemed to him
appropriate. On the other hand, he did not approve of
paracentesis abdominis in cases of dropsical effusion, as a
means of evacuating the fluid accumulated in the peritoneal
cavity.

It appears that the disciples and successors of Herophilus
and Erasistratus soon abandoned the exact methods which
these two great masters had inaugurated and which, in a
comparatively short time, had produced such admirable

ERASISTRATUS AND HEROPHILUS 111

results, and then they fell back into the less arduous, the
easy-going ways of speculation. Only a very few had
sufficient strength of character to walk in the older path-
way, and among the number were some who left Alexandria
and established schools in the other cities — as, for example,
Zeuxis, who organized a new centre of medical teaching at
Laodicea, in the interior of Asia Minor, and Hikesios, who
founded another school at Smyrna, on the seacoast of
Lydia. It is not strange, therefore, that before many years
had elapsed the two original schools at Alexandria died a
natural death. As Pliny aptly writes, **It was so much
more comfortable to sit on the benches of the schools and
have learning poured into your ears than to wander daily
through the desert outside in search of other nourishing
plants. " As a further result of this deadness of the schools
at Alexandria (that is, of the sect of the Dogmatics) the
more serious-minded physicians espoused with eagerness
the side of the Empirics — a sect which developed about this
time, but which did not, it must be confessed, hold out much
hope of solving the physiological and pathological problems
of the day, but which nevertheless satisfied in some measure
their needs as practitioners.

Philinus of Cos (286 B. C.) was looked upon as the
founder of the school of the Empirics, and among its most
distinguished disciples were: Serapion of Alexandria
(279 B. C), Glaucias, Apollonius Biblas, and — perhaps the
most celebrated of them all — Herakleides of Tarentum
(242 B. C), who did such excellent work in the department
of pharmacology. It was he, for example, who defined
more precisely than had been done by any one of his
predecessors the proper manner of employing opium. In
addition, he wrote a commentary on the Hippocratic
works and also separate treatises on medical, surgical and
pharmaceutical topics. In the latter category belongs his
book entitled **A Military Pharmacopoeia." Last of all,
Apollonius Mus, a distinguished follower of Herophilus,
deserves to be mentioned because it was he who perfected
the preparation of castor oil. At a still later date (158
B. C.) Zopyrus proved himself to be a most worthy sue-

112 GROWTH OF MEDICINE

cesser to Herakleides. It was he who first classified drugs
according to the effects which they produce, and he also
invented or discovered the preparation named ''ambrosia,"
a general antidote for poisons of all kinds. Kings and
princes were, at that period, in constant fear of being
poisoned, and so it came about that those who were skilled
in the knowledge and preparation of drugs were greatly
stimulated by their royal patrons to find efficient antidotes.
It is narrated that Attains Philometer, King of Pergamum,
the native city of the famous physician Galen, and Mithri-
dates Eupator, King of Pontus, cultivated poisonous plants
in their gardens and tried the effects of the poisons distilled
from them on criminals. They also encouraged in every
possible way the preparation of antidotes; and thus was
compounded a mixture which even to-day is still known by
the name of ^^Mithridaticum." For centuries it was a very
popular remedy for poisoning by snake-bite. Le Clerc
states that one of the first things that the great Roman
general Pompey did, after conquering Mithridates and
gaining possession of his palace (about 64 B. C), was to
have a careful search made for the recipe of this famous
antidote. Upon finding it he was surprised to learn what
simple ingredients it was composed of — viz., ''20 leaves
of rue, a pinch of salt, two nuts, and two dried figs. ' ' The
theriacum, which one hundred years later was modeled
after the Mithridaticum, contained a great deal of honey
and a large number of unimportant drugs, introduced — as
Pliny claims — "to magnify the importance of the apothe-
cary's art, rather than to increase the curative effects of
the remedy."

The scepticism which already at that period had begun
to take possession of many of the best minds manifested
itself in the form of a disbelief in the possibility of
discovering full scientific truth, and men therefore taught
the doctrine that the human understanding is not capable
of attaining anything higher than probability. The accept-
ance of such a doctrine naturally acted as a powerful
hindrance to all further original research. And so the
Empirics neglected the study of anatomy and physiology

ERASISTRATUS AND EEROPHILUS 113

as something quite superfluous and unprofitable. They
gave no further thought to the causes of disease, and were
quite satisfied simply to observe its manifestations, to
investigate the factors which appeared to bring it into a
state of activity, and to search for the means of eifecting
a cure. In carrying on work of this character, they of
course derived help, not only from their own experience,
but also from that of others — which latter became in time
a matter of history. When they encountered new expe-
riences and were unable to supply a satisfactory expla-
nation they resorted to a third method — that of reasoning
by analogy. Upon this triple support — one's own indi-
vidual experience, the experience of others stored up in
the form of history, and reasoning by analog}^ — rested the
entire structure of empiricism.

Strange as it may at first appear, the science of medicine
from this time onward made no further conspicuous
progress until the middle of the seventeenth century of the
present era. In certain branches of practical medicine —
as, for example, pharmacology, obstetrics and general
surgery, and also in certain special departments — the
Empirics made a number of material additions to our
knowledge; but in all essential particulars the toiedical
science taught throughout this period of about two thou-
sand years varied but little from that taught at Alexandria
one hundred or two hundred years before the birth of
Christ. This extraordinary phenomenon of almost com-
plete arrest of development for so long a period of time
should not excite surprise, for something of a similar
nature has certainly occurred in other departments of
human knowledge.

The further history of the medical sects which flourished
under the Ptolemies and for a short time afterward, when
Alexandria became a colony of the Roman Empire, need
not detain us long. Daremberg furnishes a chronological
chart of the physicians who played a more or less prominent
part in the work of these sects, and from this it appears
that they numbered thirty-four in all — ten followers of
Herophilus, fourteen of Erasistratus, and ten Empirics.

114 GROWTH OF MEDICINE

Callamachur and Bacchius, who belonged to the first of
these groups, deserve to be mentioned because they were
its most distinguished members and because they were the
first physicians who wrote commentaries on the writings
of Hippocrates. In the sect of the Empirics the next in
importance after Philinus of Cos is Serapion of Alex-
andria. Mantias, another disciple of Herophilus, gained
considerable reputation from the fact that he was the first
to collect together into a single treatise the different
pharmaceutical formulae that were then in general use.
He was also an authoritative writer on surgical topics.

Certain Branches of Medical Work Begin to Assume
more Distinctly the Character of Specialties.- — At the time
of Hippocrates there were no specialists, or at least none
who received any sort of official recognition from the
general body of physicians ; and yet, there were, even then,
a few practitioners who devoted themselves preferably to
the treatment of certain maladies, like the affections of the
eye and the teeth; and, beside these, there were undoubt-
edly, in the larger communities, men who were ready and
competent to undertake the more serious surgical opera-
tions. But even these men, as appears from the language
of the so-called Hippocratic oath, could not honorably
perform an operation for stone in the bladder; this
particular work having been left from time immemorial
entirely in the hands of the lithotomists, a class of men
who performed no other kind of surgery and who, in
fact, were considered outside the pale of the medical
profession — ^merely surgical artisans.

During the Alexandrian period the attitude of the best
physicians with reference to specialization in medical
practice evidently underwent a change, — not a very marked
one, it is true, but yet sufficient in degree to attract some
attention. We read, for example, that a certain Demetrius
of Apamea, a follower of Herophilus, was skilled as an
obstetrician and was also a clever diagnostician; that
Andreas of Carystus, another disciple of Herophilus and
the physician upon whose authority the incredible story
of the burning of the Cnidian archives by Hippocrates was

ERASISTRATUS AND HEROPHILUS 115

spread abroad, was considered at this time an expert in the
science of obstetrics; that, toward the end of the period
(first century B. C), Alexander Philalethes, a disciple of
Herophilus and well known as an author of treatises on the
pulse and on the doctrines taught by different physicians
of that period, acquired widespread celebrity as a gynae-
cologist; that Straton, a disciple of Erasistratus, had
gained considerable distinction as a gynaecologist; and,
finally, that two physicians — Gains of Naples and Demos-
thenes of Marseilles (Massilia) — were widely celebrated
for their skilfulness in the treatment of eye diseases. The
latter was also a successful author, for his treatise on
ophthalmology retained its popularity down to the Middle
Ages. All these men, it should be noted, were directly and
indirectly connected with the work at Alexandria, and were
physicians of some degree of prominence. It is fair to
assume, therefore, that specialization in medical practice
had by this time become an accepted fact and was certainly
not frowned upon by those in authority. The result is
entirely in accord with what might be expected from a body
of physicians as enlightened as were the men gathered
together at Alexandria during the centuries immediately
preceding and that immediately following the birth of
Christ; but many additional centuries were yet to elapse
before anything like the well-defined specialism of modern
times was to become an established fact.

CHAPTER XI

ASCLEPIADES, THE INTRODUCER OF GREEK
MEDICINE INTO ROME

The seventh Ptolemy, Ptolemy Euergetes or Physcon,
whose reign lasted from 146 to 117 B. C, drove all men of
learning away from Alexandria and closed the famous
schools in that city. It was only a few years after these
events, and at a time when that city was fast losing its
supremacy as the great centre of medical learning,^ that
there appeared at Rome a Greek philosopher and physician
who was destined to become the founder of a new set of
medical ideas and of a new kind of medical practice. Being

1 After Alexandria first came under Eoman rule (about 30 B. C.) member-
ship in the Museum was granted to athletes and other men of no education,
and it is said that even before that time Ptolemy Euergetes, who had reopened
the schools during the latter part of his reign, bestowed some of the important
positions upon men who were simply his favorites. The library of the Museum
was seriously damaged by fire at the time when Julius Caesar was being
besieged in Alexandria by the inhabitants of that city, and was at last wholly
destroyed by Amrou, the Lieutenant of the Caliph Omar, in A. D. 651. The
truth of this extraordinary tale regarding the burning of books belonging to
the library at Alexandria in the seventh century is seriously doubted by
Sismondi (Histoire de la Chute de I'Empire Bomain, Vol. II., p. 57). "It
was," he says, "published for the first time, by Abulpharagius, about six
centuries after the event is supposed to have occurred. And yet the con-
temporaneous national historians, Entychius and Elmacin, make no mention
of it whatever. An act of this nature, furthermore, would be in direct conflict
with the precepts of the Koran and with the profound respect which the
Mohammedans habitually entertain for every scrap of paper on which the
name of God happens to be written,"

Under the later rule of the Eomans, Alexandria regained a good deal of
its literary importance and also became a chief seat of Christianity and
theological learning; but as a centre of medical influence its glory had long
since departed.

ASCLEPIADES 117

a man of general cultivation and attractive personality,
and not afraid to encounter the prejudices and ill will which
almost always greet a foreigner when he first establishes
himself in a strange country and among a people of a
different race, he soon overcame those obstacles and was
eventually successful in making Rome the starting-point
and centre of the best medical thought and practice of that
period of the world's history. To understand clearly,
however, the character of the work which Asclepiades
accomplished in the city which was soon to be the capital
of the world as then known, it is desirable that a brief
account should be given of the condition of medical affairs
in Rome at the time of his arrival.

The Practice of Medicine at Rome During the Century
Immediately Preceding the Christian Era. — Foreigners
were not encouraged to settle in Rome until toward the
latter part of the second century B. C, and consequently
the treatment of the sick in that city maintained its
distinctly Roman character for an unusually long time.
In the households of the better classes the head of the
family commonly prescribed for any illness which might
befall its members. In not a few instances one of the
slaves — who was known as a servus medicus, and who
might perfectly well have been a regularly educated Greek
physician — took charge of the patient in place of the.^
master of the house. A book of domestic remedies was the
usual source of information from which the latter derived
his knowledge of therapeutics. Marcus Porcius Cato, the
distinguished Roman censor (234-149 B. C), was the
author of one of the most popular of Jkese books of recipes.
The text of this work has come down to our time. There
were, at this period, no regularly established physicians
and no such thing as a medical practice. For several
hundred years the Romans were almost constantly at war
with the neighboring tribes or nations, and this life of
outdoor exposure and active exercise kept them free from
the numerous and very varied bodily ills of the later
generations. This state of society alone was quite sufficient
to prevent the thoroughly trained physicians of Greece and

118 GROWTH OF MEDICINE

Alexandria from settling in Rome. But there were still
other forces at work which greatly delayed their taking
such a step, viz., the unwillingness on the part of the
authorities to grant to foreigners the rights of citizenship,
and the very strong prejudice which the Roman aristocracy
cherished with regard to the Greek nation. Some idea of
the strength of the latter feeling may be gathered from the
letter which Cato the Censor, perhaps the most influential
citizen of Rome at that time, wrote to his son Marcus.
Daremberg gives the following quotation from this epistle :
' * The Greeks are a perverse and unteachable race. Believe
that an oracle is speaking to you when I say — Every time
that the Greeks bring to us some branch of knowledge they
will not fail to corrupt our manners; and it will be far
worse for us if they should send us their physicians, for
they have bound themselves by an oath to kill all Bar-
barians by the aid of medicine — and they have the insolence
to reckon us also as Barbarians. Remember that I have
forbidden you to call in a physician." Daremberg adds:
**The old man Cato must have been very simple-minded
to believe for a moment that physicians would be such
egregious fools as willingly to kill the patients from whom
they derive their support. ' ' But even this strong prejudice
on the part of the Roman aristocracy had to give way in
course of time to forces of a much stronger character.
During the second century B. C, the Romans, no longer
fearing the encroachments of their warlike neighbors and
having overcome all danger of an invasion on the part of
their once powerful Carthaginian foe, entered upon a career
of conquest. The capture of an ever increasing number
of cities and towns in Greece, Asia Minor, Egypt and
Africa brought great wealth to Rome, and, with it, increas-
ing luxury, an increase in the prevalence and variety of
diseases, and an increased need of men who were competent
to deal successfully with such diseases. The physicians
who first attempted to meet this need were men of an
inferior stamp, to whom the situation appeared simply to
afford an excellent opportunity for making money; and
very naturally they failed to gain the respect and confidence

ASCLEPIADES 119

of the better citizens. At a later date Julius Caesar, who
was, at that time, Consul (about 90 B. C), extended the
right of citizenship to all foreign physicians who were
practicing in Rome, and thus was removed one of the
greatest obstacles which prevented the better class of Greek
medical men from settling in that city.

More than a hundred years before the time of which I
am speaking {i.e., about 218 B. C), a Greek physician
named Archagathus had the courage to take up his abode
in Rome. He was the son of Lysanias, a native of Pelo-
ponnesus. At first he appeared to gain the favor of the
community in which he practiced, for they bought and
placed at his disposal a shop, or office, in the cross-way of
Acilius, and gave him the name of vulnerarius — healer of
wounds. Later, however, they disliked his rather too free
use of the knife and the actual cautery, and thereafter he
was spoken of as the carnifex, or executioner. Medicine
was thus brought into disrepute and we hear nothing
further about physicians in Rome for more than a cen-
tury— that is, until about 90 B. C, when Asclepiades,^ a
native of the city of Prusa, Bithynia (northwest part of
Asia Minor), made his appearance in that city. At first he
taught rhetoric, but, finding this occupation unprofitable,
he began the practice of medicine. Pliny says that he
acquired a knowledge of this art through the studies which
he carried on after his arrival in the city of Rome, but
Neuburger makes the statement that he began the study
of rhetoric, philosophy and medicine in his youth and then
spent some time in perfecting his knowledge at Parion, a
city of Mysia on the Hellespont, at Athens, and probably
also at Alexandria.

As a practitioner Asclepiades appears to have met with
unusual success. He was well educated and possessed of
agreeable manners, and was the friend as well as the
physician of Cicero, one of the most polished men of whom
history furnishes us any knowledge. He was also on terms
of intimacy with Atticus and other eminent citizens of

2 Asclepiades was not a descendant of Aesculapius, as one would naturally
infer from the name which he bore.

120 GROWTH OF MEDICINE

Rome. The possession of such friends was more than
sufficient to render him one of the favored and prosperous
physicians of his day in that city. As Meyer-Steineg aptly
says, *'he owed not a little of his success to the happy
manner in which the scientist, the clever physician, and —
to a slight degree — the charlatan were combined in his
character." The following anecdote which is told of him
by Lucius Apuleius shows, on the one hand, that he
possessed remarkably keen powers of observation, and,
on the other, that there were some grounds for the
charge that his behavior was at times somewhat theatrical
in character: —

One day, as Asclepiades w?is returning to the city, from his
place in the country, he observed the approach of a long
funeral procession. Desiring to learn whether the deceased was
a person of his acquaintance, and also in the hope of perhaps
gaining other information of a professional nature, he approached
as nearly as possible to the bier. The face of the corpse was
anointed with sweet-smelling ointments over which spices had
been sprinkled; but, notwithstanding this, he was able to detect
certain signs which led him to suspect that the man might not
yet be dead; and accordingly he examined the body very closely
and thus satisfied himself that such was indeed the fact. Where-
upon he called aloud that the man was still alive, and told the
bearers to extinguish the torches, to carry away the materials for
the pyre, and to remove the funeral feast from the grave to a table.
Some at once objected to the carrying out of these measures and
made sarcastic remarks about the healing art — probably because
they were already in possession of the man's estate, and were afraid
that they might have to give it up. The more influential ones,
however, insisted that the physician's words should be heeded.
Then Asclepiades, notwithstanding the opposition which was made
by the relatives, succeeded in securing a brief delay, during which
he had the supposed corpse removed to his own house. Restorative
measures were employed, respiration was re-established, and the
man was brought back to life. At the succeeding festivities
unlimited praise was bestowed upon the wise physician.

Whether this tale, which I have copied from Neuburger,
is true or not, it seems to fit in well with the bold and

ASCLEPIADES 121

independent character of Asclepiades as it is revealed to
us by the different writers of the history of medicine. In
his comment upon this narrative the distinguished Viennese
historian makes the remark that Asclepiades was very
conceited, and — like most reformers — showed a disposition
to ignore the work accomplished by his predecessors. He
also expresses the belief that Asclepiades possessed a
leaning toward the methods of the charlatan; the episode
just narrated revealing a love for theatrical display in his
professional activity. On the other hand, in the further
course of the chapter which he devotes to this famous
Eoman physician, Neuburger gives fuller recognition to
the value of the services which he rendered to medicine,
and thus, in the light of these services, one is justified in
overlooking any little weaknesses of character which he
may have displayed. Perhaps the most important of the
services which Asclepiades rendered was that of having
introduced Greek medicine into Rome — an important con-
necting link in the transmission of medical knowledge from
Greece to Modern Europe.

The Views of Asclepiades with Regard to Physiology
and Pathology. — The human body, according to the
philosophy of Asclepiades, is composed of atoms — that is,
small bodies which are invisible, have no definable quality,
are in continual motion, through mutual pressure undergo
modifications in form, and break up into innumerable
smaller fragments or particles that differ both in size and
in shape. The arrangement of these small bodies is such
that intercommunicating spaces or pores are left between
them, and through these channels flows a sap or juice
containing larger and smaller particles; the larger ones
composed of blood, and the smaller of vapor or heat.
Health, according to Asclepiades, is that state in which the
primitive atoms are properly distributed or placed and the
flow of the juices in the pores takes place normally. When,
however, the flow is arrested and the primitive atoms are
disordered in their relations to each other and to the pores,
or when the elements composing the fluid contents of the
latter become mixed, disease results. Alterations in the

122 GROWTH OF MEDICINE

pores themselves, as contradistinguished from the fluid
contained within them, may also cause disease. Farther
on, when the proper time arrives for considering the sect
of the Methodists, I shall have occasion to discuss this
subject again, and particularly that part of it which relates
to pathology. In the meantime, however, I cannot resist
the impulse to say a few words about the remarkable
insight possessed by Asclepiades into the manner of
construction of the human body, as manifested by this very
brief but very significant anatomical and physiological
description. Upon a first reading one might easily get the
impression that Asclepiades has reference to only one kind
or system of *' pores" or channels — viz., such as serve for
the circulation of tissue juices alone. But, upon a closer
scrutiny of the text, one finds some warrant for suspecting
that he had in mind more than one system of such channels ;
for he states distinctly that the fluid circulating in these
pores contains larger particles composed of blood and
smaller ones which consist of vapor {spiritus) or heat.
The question suggests itself: Could a man who had no
knowledge of Harvey's discovery, who did not possess a
microscope, and who at the same time believed — as did all
the ancients — that air circulated in the arteries and blood
in the veins, come any nearer to the actual truth than did
Asclepiades? His description needs very few alterations
and additions to make it fit correctly the system of terminal
arterio-venous channels known to-day as arterioles and
capillaries.

Methods of Treatment Adopted by Asclepiades. — The
prevailing methods of treating diseases in Rome were not
approved by Asclepiades, and he lost no opportunity of
giving expression to this disapproval. In the first place,
he protested vigorously against the practice of prescribing
on every possible occasion purgatives and remedies capable
of producing vomiting. He had a decided preference for
gentler measures, his idea being that a physician should
cure his patients tuto, celeriter, et jucunde — safely, quickly
and agreeably. Le Clerc adds that this is a fine sentiment,
but that its realization in actual practice is something

ASCLEPIADES 123

which most physicians find it very difficult to attain.
Asclepiades condemned strongly the employment of
magical remedies, a practice which was still much in use
at that time in Rome, although it was already less common
than it had previously been. Cato 's collection of household
remedies contains a short list of some of these appeals to
man's superstition.^ In addition to the remedial measures
mentioned above, Asclepiades placed his chief dependence
on the following: abstinence from meat; the employment
of wine under certain well-defined circumstances ; massage
and frictions; baths of different kinds (it is said that he
devised a great variety); walking; driving and being
carried about in the open air in a litter or in a boat on a
quiet river or in the protected harbor. One of his remedies
in the case of sleeplessness consisted in having the patient
placed in a suspended couch which could easily be rocked
from side to side. As all these measures were agreeable
and could at the same time easily be employed by almost
everybody, they met with general favor, and in consequence
Asclepiades was looked upon by the Romans as '*a person
sent from heaven." As a rule, he recommended the
drinking of simple water, but in certain cases (to be
mentioned farther on) he did not hesitate to advise the
taking of wine in moderation. He advocated tracheotomy,
in cases of inflammation of the throat, in preference to the
then prevailing practice — both very painful and quite
difficult to carry out — of introducing a tube of some kind
as a means of opening a passage for the entrance of air
into the lungs.

Le Clerc quotes Galen as authority for the statement that
Asclepiades, who never hesitated for an instant to criticise
the different therapeutic procedures of his predecessors,

8 It would not be easy to fix, even approximately, the date when remedies
of this character ceased to find acceptance in the popular mind of Europeans,
but there can be no doubt that they were employed rather frequently even
as late as during the eighteenth century; — indeed, measures that strongly
smack of superstition are now and then looked upon with favor by the well-
educated members of our modern society. For many centuries, however, they
have been abandoned by all physicians excepting those who are unworthy to
bear that honored title.

124 GROWTH OF MEDICINE

did not go so far as to condemn wholly the practice of
bloodletting. Indeed, he was quite ready to employ it in
the treatment of painful affections because, as he claimed,
the pain was caused ''by the retention of the larger
particles or atoms in the pores or channels of the tissues,
and hence — as these particles were composed of blood —
bloodletting was the only remedy capable of setting them
free." Thus, he resorted to bleeding in pleurisy, because
this affection is characterized by pain; but he abstained
from employing the remedy in ''peripneumonia" or
"inflammation of the lung," because in most cases it is
not accompanied by pain; and he also did not approve of
its employment in inflammation of the brain {phrenitis).
On the other hand, he advocated bleeding in epilepsy and
all forms of disease in which convulsions occurred, and he
also advocated it in cases of hemorrhage of every descrip-
tion. Quinsy sore throat was another malady in which he
drew blood freely from the veins of the arm, of the temple
and even of the tongue ; and in addition, when the disease
was severe, he scarified the skin at suitable spots and
applied cups to the part. In all these measures his purpose
was "to open the pores"; and when this treatment failed
he incised the tonsils or the uvula, and even, as a last
resort, performed laryngotomy or tracheotomy. In cases
of dropsy he employed paracentesis abdominis, — that is,
he made a very small opening in the abdominal wall to
serve as an outlet for the fluid contained in the peritoneal
cavity. From these facts it is evident that Asclepiades did
not always abide by his rule not to use any but very gentle
remedies.

Asclepiades showed, in his manner of treating still other
pathological conditions, how different was his practice from
that of his predecessors. In the first place, he was very
partial, as has already been stated, to such extremely mild
forms of physical exercise in the open air as one can obtain
from driving or from being carried in a litter or a boat.
He prescribed these measures, not merely for convalescents
but also for those, for example, who were still in the midst
of an active fever. His idea was, that by means of such

ASCLEPIADES 125

very gentle forms of exercise the pores would become less
clogged and would permit the juices of the body to flow
more freely. In cases of dropsy, also, he was in the habit
of employing friction for precisely the same purpose. He
even used this remedy in cases of inflammation of the brain,
in the expectation that he might thereby induce sleep for
these patients. Indeed, this subject of frictions was one
on which Asclepiades wrote at greater length than on any
other remedial agent.

It is a surprising fact that, in common with Erasistratus,
he taught the doctrine that physical exercise was not at all
necessary to persons in normal health. At the same time
he approved of it, when carefully graded, for those who
were affected with bodily ills of a certain nature.

Wine was another remedy which Asclepiades was fond
of prescribing in all sorts of maladies, but his rules in
regard to the manner in which it should be employed were
quite different from those adopted by his contemporaries.
A few illustrations will suffice to show the different
conditions for which he was wont to advocate the taking
of wine : He gave it, for example, — though probably much
diluted with water — to patients affected with fever, but
only after the stage of greatest activity had been passed.
Strange as it may appear to-day, he was rather in favor
of giving to patients ill with inflammation of the brain
(phrenitis) wine in sufficient quantity to produce intoxi-
cation; his belief being that he could in this way induce
drowsiness and eventually sleep) — a thing so desirable for
those affected with that disease. Further, he instructed
sufferers from catarrh to drink twice or three times as
much wine as they usually drank, in consequence of which
instructions the patients found it necessary to dilute their
wine with water to a less degree than usual — that is, to
such a degree that the proportion would be one-half of
each; thus showing, as Le Clerc remarks, how sober the
ancients must have been when they were in perfect health.
They probably — he adds — drank their wine ordinarily in
the proportion of five-sixths water to one-sixth wine, or,
at most, three-quarters water to one-quarter wine.

126 GROWTH OF MEDICINE

In some cases Asclepiades prescribed the drinking of
wine (particularly the wine of Cos) to which sea-water had
been added; his idea being that the addition of salt would
enable the wine to penetrate farther into the tissues and
thus open the pores more freely. This idea of added salt
was not original with him, for Pliny states that in certain
parts of Oreece it was customary to place casks filled with
new wine in the sea and to leave them there for some
time. The wine, it was claimed, was rendered by this
procedure mature and pleasanter to drink. They called
wine thus treated ''Thalassite wine" (from the Greek word
'^thalassa," sea). In cases of jaundice he occasionally
recommended the drinking of plain sea-water, whereby the
bowels were stimulated to act more freely. Under ordinary
circumstances he employed, for the relief of constipation,
clysters, but he was sparing in their use.

The remedial measures enumerated above, together with
dieting, are those upon which Asclepiades chiefly relied in
his practice. In acute diseases he made very little use of
drugs that were to be taken internally, but in maladies
of a chronic character he employed them quite freely.
Gargles, poultices and inunctions are mentioned among the
external remedies which he often prescribed.

Further Particulars Regarding the Life and Career of
Asclepiades. — Le Clerc furnishes a number of details which
throw additional light upon the career of Asclepiades.
During the latter 's lifetime his professional reputation was
very great. Lucius Apuleius, the famous Eoman satirist
and rhetorician, and a contemporary of Asclepiades, calls
him the Prince of Physicians, second only to Hippocrates
the Great; Scribonius Largus, a Roman physician and
writer, who flourished during the reigns of the Roman
emperors Tiberius and Claudius (37-54 A. D.), speaks of
him as a great medical author ; Sextus Empiricus, a writer
remarkable for his learning and acumen, who lived in the
first half of the third century A. D., calls him a physician
of unrivaled skill; and Celsus, who is termed the Cicero
of physicians, on account of the purity of his Latin, holds
him in high esteem as a medical authority. His fame as a

ASCLEPIADES 127

physician had spread to Asia Minor, for we are told that
Mithridates, King of Pontus, who reigned from 120 B. C.
to 63 B. C, and who was a man of great ability and great
energy, invited him to take up his residence at his court;
but Asclepiades refused. Perhaps a still stronger evidence
of his real worth as a man is to be found in the fact that
he was the physician and personal friend of Cicero.

Notwithstanding these strongly favorable estimates of
the ability of Asclepiades there were not a few men, and
they too men of great authority, who were indisposed to
give him so conspicuous a place in the temple of fame.
Galen, for example, while admitting that he was a very
eloquent physician, maintained that he was a sophist, given
to quibbling, and disposed to contradict everybody.
Caelius Aurelianus, a contemporary of Galen and the
author of the most important practical treatise on Metho-
dism that has come dowTi to our time, appears to have held
the same opinion as Galen with regard to Asclepiades.
The complete disappearance of all the writings of the latter
author makes it impossible for us at the present time to
form an independent judgment as to the merits of these
conflicting estimates of the man's character. Galen was
a great admirer of Hippocrates and it is very likely that
he took offense at the failure of Asclepiades to accept all
the teachings and therapeutic methods of his hero. As to
the reasons which led Caelius Aurelianus to agree with the
estimate made by Galen, we know absolutely nothing.

Toward the middle of the seventeenth century there was
discovered at Rome, not far from the Capena gate, a
portrait bust in white marble of Asclepiades. It was
probably executed by a Greek sculptor residing in Rome,
for, if the work had been done in Greece, the face would
have been represented with a beard, as are the heads of
Hippocrates, Soranus and other celebrated physicians of
antiquity. The absence of the beard, furthermore, shows —
according to the opinion of antiquarian experts — that the
bust must have been sculptured before the time of the
Emperor Claudius (41-54 A. D.), as he was the first of the
Caesars to wear a beard. This bust, which is a little larger

/■

128 GROWTH OF MEDICINE

than life size, is at present — if I am rightly informed —
in the Capitoline Museum at Rome.

Asclepiades lived to a great age. In descending, one
day, a flight of steps he fell and received injuries from
which he died.

CHAPTER XII

THE STATE OF MEDICINE AT ROME AFTER THE
DEATH OF ASCLEPIADES; THE FOUNDING OF
THE SCHOOL OF THE METHODISTS

In summing up the effects which were produced by the
teaching and practice of Asclepiades upon the science and
art of medicine, Dr. Meyer-Steineg makes the remark that
the wide and ready acceptance of both depended largely
upon the personal character of the man, upon the manner
in which he carried out the measures which he advocated,
and upon the fact that the Romans happened at that period
of their history to be ready to respond favorably to such
new doctrines and therapeutic methods; but that, as soon
as his strong personality had ceased to exert its influence,
as it did after he had passed the active period of his life,
and also because Rome did not at that moment possess any
physicians who were sufficiently endowed with his medical
gifts and sagacity to perpetuate his art, both it and his
doctrines began to lose ground. Nevertheless, as this
writer states, Asclepiades had already succeeded admirably
in preparing the way for a further development of the
healing art, and for this valuable service full credit should
be given him.

Not long after the death of Asclepiades, Antonius Musa,^
the personal physician of the Emperor Augustus, suc-
ceeded, by means of hydrotherapy, in curing his royal
patient of a protracted gouty or rheumatic affection from
which he had been a sufferer ; and, as a mark of gratitude
for the cure which he had effected, the Emperor raised him

1 Neither Haller nor Dezeimeris furnishes any biographical information
with regard to Musa.

130 GROWTH OF MEDICINE

to the rank of a noble (about the year 10 A. D.), erected
a statue in his honor in the temple of Aesculapius, and at
the same time issued a decree that from that time forward
the physicians who practiced in Eome should be exempted
from taxation and from certain other civic burdens. These
privileges, which were afterward confirmed by Vespasian
(70-79 A. D.) and also by Antoninus Pius (138-161 A. D.),'
were of great advantage to the medical profession as a
whole. Julius Caesar (100-44 B. C), it will be remembered,
had already (about half a century earlier) bestowed
Roman Citizenship upon the physicians who practiced
their profession in that city. Thus, at the time of which
we are now speaking, the medical men of Rome occupied
the enviable position of being on an equality with their
fellow citizens of the better class, a position which made
it attractive for young men of ability and of good social
standing to enter the profession.

Among the numerous followers of Asclepiades the most
distinguished was undoubtedly Themison of Laodicea, a
city of Phrygia, Asia Minor, who flourished about the
middle of the first century B. C. When he was well
advanced in years he wrote a medical treatise in which
he developed a system of pathology and therapeutics that
was accepted as the professional creed of the sect known
as *' Methodists. " Starting from the doctrine of pores and
primitive atoms taught by Asclepiades, he laid great stress
upon the idea that in disease all the alterations which
take place in the tissues may be classed in one or the other
of these two categories — a relaxation ^iJaa;2*m) or a con-
traction (strictum) of the parts. To these two categories,
which the Methodists termed ** communities, " and which
were the only ones at first accepted as a part of their creed,
a third was soon added, viz., that condition in which both
relaxed and contracted states appear side by side, although

not necessarily both of them developed to the same degree ;

«

2 Antoninus Pius, however, established the rule that these privileges were
not to be granted to all physicians indiscriminately, but only to a limited
number; and, later still, it was decided that only the parish physicians were
entitled to receive them.

TEE STATE OF MEDICINE AT ROME 131

and to this third category or *' community" they applied
the term ^^mixtum." The ideas which are here stated in
a somewhat crude and imperfect manner owing to my lack
of knowledge of all the facts, constitute the basis of the
pathology of the ''Methodists" — a pathology which held
its own in the domain of medicine during a period of four
hundred years, and which — in contradistinction to the
humoral pathology of Hippocrates — is justly entitled to
the name of ''solidist pathology." This doctrine, as might
be expected, underwent certain modifications during this
long period of time, but they were not serious enough to
alter materially the fundamental form of the teaching as
it has here been described.

Themison and his followers, like their distinguished
predecessor, Asclepiades, possessed something more than
a mere glimmering of the truth in pathology as we know
it to-day; and this idea suggests the further thought that
Morgagni, Rokitansky, Lebert, Virchow and perhaps others
whose names do not now occur to me, could scarcely have
developed a better pathology if they had lived during these
first centuries of the Christian era — a period of time when
public sentiment did not permit postmortem examinations,
when Harvey's discovery was not even dreamed of, when
the microscope was unknown, and when experimental
pathology was an impossibility. Many centuries had still
to elapse before medicine could gain that freedom of action,
that rich equipment of tools, and that stock of accumulated
knowledge which enable her in these days to make such
giant strides forward as we have witnessed during the past
twenty or thirty years.

The question will naturally arise. How did the Metho-
dists decide, in the presence of an actual case of illness,
which one of these abnormal states (the laxum, the strictum,
or the mixtum) was the condition that called for medical
treatment? The answer which they gave to this question
was, that the condition of the different secretions and the
dejections furnished the principal indication as to what
particular part or organ of the body was ailing, and also
as to what was the nature of the morbid change or process

132 GROWTH OF MEDICINE

that produced the malady. When, for example, the secre-
tion from an organ or part was excessive, they inferred
that the pores of such a part were relaxed and distended,
thus permitting an increased flow; and when the secretion
was less than it should be, they decided that the pores were
contracted. The status mixtus had reference to those cases
in which a condition of relaxation was observed in one part
of the body, while that of contraction was noted in another.

Neuburger mentions the fact that the Methodists were
somewhat arbitrary in their classification of the different
diseases, most of the acute maladies being placed by them
under the heading Status strictus, while they assigned the
majority of the chronic affections to the category of Status
laxus.

The effect of the tendency of the Methodists to classify
and simplify all the departments of medicine was not
wholly beneficial. It conveyed to many the impression that
medicine might readily be learned in the course of a few
months, and thus offered the temptation to inferior
men to choose the career of physician; and yet, on the
other hand, it infused into the art the essentially Eoman
characteristics of orderliness, simplicity and efficiency.
Anatomy, for example, was studied only so far as a knowl-
edge of this department of medicine was necessary to
render the physician familiar with the location, general
character and relations of the different organs. There was
one field, however, in which the adherents of this school
displayed a high degree of excellence, viz., in their descrip-
tions of disease ; and this is especially true of those written
by Caelius Aurelianus (fourth century A. D.), whose
manner of handling the subject of differential diagnosis is
far more thorough and satisfactory than that of any of the
medical authors who preceded him.

In their treatment of disease, the Methodists were largely
guided by the principle of contraria contrariis, — i.e., in
those cases in which, to the best of their belief, a status
laxus existed, they administered astringents, in the hope
of thereby bringing the parts back more nearly to a
contracted condition; and, vice versa, when the diagnosis

THE STATE OF MEDICINE AT ROME 133

of status strictus was made, they gave a relaxing medicine.
The terms *' laxatives" and '* astringents, " which are still
applied to many drugs, were originated by the Methodists.
Bloodletting, for example, was one of the remedies which
they used for producing relaxation, and an astringent was
employed when a contrary effect was desired. In the list
of relaxing remedial agents (aside from bloodletting) were
placed the following: warm baths, poultices, inunctions
with warm oil, vapor baths, fasting and a restricted diet,
diuretics (very carefully watched and employed only in
exceptional cases), emetics, diaphoretics and laxatives.
The following agents, on the other hand, were classed as
contracting, astringent and tonic remedies: washing with
cold water, cold baths, the application of cloths dipped in
cold water, living in cold air, strengthening diet, wine,
vinegar, alum, narcotics, etc. Themison, it should be
added, is the first one among the ancient writers to mention
the use of leeches as a means of extracting blood. It does
not follow from this, however, that he was the discoverer
of this method of local bloodletting ; for it is highly probable
that this procedure had been in common use for many years
previous to his time.

Themison, as I have before stated, was an old man when
he laid the foundations for Methodism, and it is not
probable that it attained much importance as a sect until
several years after his death. Then Thessalus, a native
of Tralles, a flourishing commercial city of Asia Minor,
and a man who had received his medical training in one of
the Greek schools, materially added to the body of doctrines
held by this sect, and at the same time rendered them more
acceptable to physicians generally. He was of humble
birth, the son of a wool carder, and his education had been
rather neglected ; but he nevertheless managed, by his own
efforts and in no small' degree by the unlimited self-
confidence (Galen calls it impudence) which he possessed,
to push his way to the top of the ladder.' He acquired a

8 It seems almost unnecessary to call attention to the fact that the subject
of these remarks is not to be confounded with Thessalus, the son of
Hippocrates.

134 GROWTH OF MEDICINE

large fortune during the reign of Nero (54-68 A. D.) and
apparently succeeded in persuading this monarch that he
was a great physician. Here are some facts which appear
to justify Galen's dislike for Thessalus: In a letter to
Nero the latter writes: **I have founded a new medical
sect, the only genuine one in existence. I was forced to do
so because the physicians who preceded me had failed to
discover anything that is likely to promote health or to
drive away disease ; even Hippocrates himself having laid
down doctrines which are positively harmful." His vanity,
according to Le Clerc, reached such a pitch that he called
himself the *' conqueror of physicians."* Pliny corrobo-
rates the latter statement in the following words : ''When
he assumed the title of 'conqueror of physicians,' a title
which was engraved, according to his instructions, on
his tomb in the Appian Way." Notwithstanding his
unbounded conceit, Thessalus appears to have made several
important improvements in the doctrines of the Methodists.
He is also, as it appears, entitled to the credit of having
been the first to inaugurate the practice of giving sys-
tematic instruction at the bedside ; thus establishing for all
time a most valuable precedent for the guidance of his
successors.

"He was an excellent practitioner and an original thinker.

He was also a prolific writer, as is shown by the number

and variety of treatises which — as we are assured by Caelius
Aurelianus — were composed by him." The same authority speaks
of him as "a leader among our chiefs," thus affording good evi-
dence of the degree of esteem in which he was held by the members
of his own school. The fact that pupils came in throngs to be
taught by him shows clearly how thoroughly he understood the
needs of the physicians of Rome. (Meyer-Steineg.)

Thessalus, notwithstanding his declaration that medicine
might readily be taught in six months, wrote a larger
number of treatises on professional topics than any student
of medicine could possibly read and digest in the course of

* larpovlKfis is the word employed in the original Greek.

THE STATE OF MEDICINE AT ROME 135

two or three years. They filled several large volumes, but
not one of them is known to exist to-day. He wrote at great
length, as we are assured, on the subject of surgery, a
subject in which he took an active interest. He taught that
ulcers, no matter in what part of the body they may be
located, require the same kind of treatment.

If an ulcer is excavated, it is necessary to bring about a filling-up
of the excavation ; if its surface is on a level with the surrounding
skin, the aim should be to make it cicatrize ; if the growth of new
tissue is excessive, the redundant portion should be destroyed by
burning with caustic ; and, finally, if the ulcer is of recent develop-
ment and bleeds readily, the attempt should be made, by approxi-
mating the edges, to effect an immediate healing.

In the treatment of chronic ulcers which show little or
no disposition to heal, and which, when they do finally heal,
are very prone to break open afresh, Thessalus urges the
great importance of ascertaining, if possible, the cause or
causes of this behavior. If it be found that the trouble is
due to some weakness or abnormal predisposition of the
part in which the ulcer is located, or that the condition of
the entire body is probably the real cause of the trouble,
he recommends the employment of ''metasyncritic reme-
dies"— that is, remedial measures which effect a marked
change in the individual's vital processes throughout the
body, and also such as exert an alterative effect upon the
ulcer itself. Among the measures of the first class he
enumerates the following: Various forms of physical
exercise; alternately increasing and diminishing the
amount of nourishment taken; and perhaps the taking
of an emetic at the very commencement of the treatment.
As to the second class of measures — those needed to bring
about a change in the ulcer itself — he makes the following
recommendations : Remove from the diseased tissues as
much as will restore the parts, as nearly as possible, to the
condition of a healthy wound, and then adopt the treatment
suited for the latter condition. In cases in which the ulcer
heals and then subsequently breaks open again, it will

^

136 GROWTH OF MEDICINE

sometimes be found beneficial to apply in the neighborhood
a plaster containing an irritating substance like mustard,
the effect of which is often to change the disposition of the
parts. In actual practice he recommends that the local
measures should be employed first, and then, if they fail
to accomplish the desired purpose, the physician should
have recourse to those enumerated in the first class — the
strictly metasyncritic remedies.

It is rather difficult to believe that a man so full of
conceit and so unjust in his criticisms of his predecessors
as Thessalus clearly was, could be capable of formulating
such a concise statement of the nature of chronic ulcers
and such a practical rule for their proper treatment. His
development of the idea of ' ' metasyncrisis " — or renovation
of the body (recorporatio), as Caelius Aurelianus trans-
lates the word — seems to have been original with Thes-
salus.^ The Methodists, it should be added, deserve special
credit for having been the first to introduce and carry into
eifect the systematic treatment of chronic diseases; and,
as a general proposition, it may be said that their treatment
of all forms of disease was thoroughly practical, free from
all tendency to resort to magical methods, and based largely
on the employment of such hygienic measures as the use
of baths of different kinds (hydrotherapy), massage,
moderate outdoor exercise, passive movements, sea
voyages, fasting, regulation of the diet, etc. One of the
favorite practices — of which Thessalus was said to have
been the originator — was to begin the treatment of almost
all maladies by prescribing an abstinence from all food for
a period of three full days. When I come to speak of
Soranus and Caelius Aurelianus I shall probably have
occasion to give further details regarding the methods of
treatment employed by the Methodists.

As a system, says Neuburger, Methodism was not capable
of inaugurating any fundamental advances in medicine;
the most that it was able to accomplish was to broaden and

5 The word ' ' metasyncrisis, " as we are assured by Le Clerc, was employed
first by Cassius, one of the earlier disciples of Methodism, and then, long after
the time of Thessalus, by Galen, Oribasius, Aetius and Paulus Aegineta.

THE STATE OF MEDICINE AT ROME 137

otherwise improve the domain of therapeutics, and some
of its wiser members were diligent in collecting and sifting
critically a large number of valuable experiences, which
were then courteously registered by them to the credit of
the sect.

CHAPTER XIII

THE FURTHER HISTORY OF METHODISM AT
ROME, AND THE DEVELOPMENT OF TWO NEW
SECTS, VIZ., THE PNEUMATISTS AND THE
ECLECTICS.— A GENERAL SURVEY OF THE
SUBJECT OF SECTS IN MEDICINE

Among the Methodists there were many physicians who
attained more or less distinction during their professional
career, but only two of them, beside those whose contri-
butions to medical knowledge have already been mentioned
in these pages, gained sufficient celebrity to justify me in
devoting some additional space to the description of the
work which they accomplished. Soranus, of Ephesus on
the coast of Asia Minor, and Caelius Aurelianus, of Sicca
in the north of Africa, are the physicians to whom I have
reference.

It was Soranus, says Le Clerc, who gave the finishing
touches to the system of the Methodists, and the work
which he did was of such excellence that he may with
justice be called the ablest and most skilful of all the
members of that school. Caelius calls him ' ' a chief among
the leaders of our sect. ' ' He received his medical training
at Alexandria and came to Rome about the year 100 A. D.
His professional career covered the period corresponding
to the reigns of Trajan and Hadrian (98-138 A. D.). He
is known to posterity chiefly through his two treatises —
one on obstetrics and gynaecology and the other on acute
and chronic diseases. The first of these treatises, in the
original Greek, was rediscovered in 1838 by Reinhold
Dietz, Professor of Medicine in the University of Konigs-

HISTORY OF METHODISM AT ROME 139

berg, Prussia, and a German translation of the work (by
Liineberg and Huber) was published in Munich in 1894.
Moschion, who was probably a pupil of Soranus, wrote a
popular treatise on the same subject for the use of mid-
wives, and in this book he has reproduced much of the
material which is to be found in the work of his master.
The treatise written by Caelius Aurelianus on acute and
chronic diseases is admitted by him to be founded on that
which Soranus wrote on the same subject. In fact, as
Daremberg states, the work of the former represents
almost a translation (into Latin) of Soranus' treatise.
The sources just named are the principal ones from which
our knowledge of this author is derived.

Soranus was a prolific writer; the treatises which he
wrote and which deal with a great variety of subjects,
number thirty in all. The majority of these works, how-
ever, have been lost. He had many followers and his
influence upon medical science was very great, not simply
during his lifetime, but also for several centuries after his
death. He commanded the respect and confidence of the
opponents of Methodism as well as of the members of his
own sect. One of his most pronounced traits of character
was his readiness to condemn, on every possible occasion,
superstitious practices, such as the employment of amulets,
magnets, etc. He was also a very persistent and earnest
advocate of the gentler and more rational obstetric methods.
For example, he disapproved of the reckless employment
of remedies for hastening the expulsion of the foetus, of
the practice of succussion (which was carried out by the
aid of a ladder), of making the pregnant woman run up
and down stairs, of a resort to rough mechanical procedures
for extracting the placenta, etc. The following quotation
from one of Soranus' treatises ( Gynaeciorum, Lib. L,
cap. 19) reveals clearly what sort of a man and physician
he was : —

There is a disagreement; for some reject destructive practices,
calling to witness Hippocrates, who says, "I will give nothing
whatever destructive" and deeming it the special province of
medicine to guard and preserve what nature generates. Another

140 GROWTH OF MEDICINE

party maintains the same view, but makes this distinction, viz. :
that the fruit of conception is not to be destroyed at will because
of adultery or of care for beauty, but is to be destroyed to avert
danger impending at parturition, if the uterus be small and cannot
subserve the perfecting of the fruit, or have hard swellings and
cracks at its mouth, or if some similar condition prevail. This
party says the same thing about preventing conception, and with
it I agree.

(Translated from the Greek by the late John G. Curtis, M.D.,
of New York.)

Soranus was not only a great obstetrician, — admitted
by all the authorities to have been the greatest in ancient
times, — he was also in high repute for the work which he
did in other departments of medicine — in gynaecology,
for example, in the instruction of midwives, in the manage-
ment of children's diseases, in the diagnosis and treatment
of both acute and chronic diseases, in surgery, etc. While
in general he adhered to the fundamental teachings of
the Methodists, he did not hesitate to depart from the
beaten pathway of that sect in his explanations of certain
pathological conditions; for he was more of a clinical
observer than a sectarian, and it was probably his inde-
pendent manner of thinking that gave the sect new vigor
and thus enabled it to live on through such a long period
of time. Galen, who was not at all disposed to speak
favorably of the Methodists, says that he tried a number
of the remedies recommended by Soranus and found them
good.

Caelius Aurelianus probably flourished during the third
century A. D. The different authorities, however, do not
agree as to the limits of the period during which he lived;
some saying that his career antedated that of Galen, while
others claim that he came upon the scene after the death
of the latter, which occurred early in the third century
A. D. His chief merit appears to have been that, through
his translation of the writings of Soranus into Latin, he
placed within reach of the physicians of Rome the teachings
of that admirable diagnostician and therapeutist; for it
must be remembered that the great majority of the Roman

HISTORY OF METHODISM AT ROME 141

medical men were not able to read Greek. On the other
hand, Caelins Aurelianus, who was himself a thoroughly
practical physician, deserves considerable credit for having
enriched the text of his book with many very appropriate
examples (chiefly with regard to questions of diagnosis)
drawn from his own personal experience, which must have
been extensive. During the Middle Ages, as we are
informed by Friedlaender, this work furnished the chief
source from which the monks derived their knowledge about
diseases and their proper treatment. The Latin in which
the book is written is described by nearly all the authorities
as barbaric.

The Pneumatists. — Methodism had been established only
a very few years when Athenaeus of Attalia, a city on the
coast of Pamphylia, Asia Minor, founded (about 50 A. D.)
a new sect — that of * * Pneumatism. " He was not the dis-
coverer of the *'pneuma" or '* vital spirit," for that had
already been admitted by the earlier schools of philosophy
as a fifth primary creative element, supplementary to the
four well-known substances — fire, air, earth and water.
He believed that heat, cold, moisture and dryness (the
primary qualities of these four bodies) were not the
veritable elements of living beings. Heat and cold, he
maintained, were ** efficient causes" and moisture and
dryness '* material causes." To these he added ''spirit"
as a fifth element ; and he taught that this spirit enters into
the formation of all bodies and preserves them in what
may be termed their natural state. It was from the Stoics,
more particularly, that Athenaeus borrowed this belief,
and it was the latter fact, as Le Clerc says, which led Galen
to speak of Chrysippus — one of the most famous of the
Stoics — as ''the Father of the Sect of the Pneumatists."

In his application of the doctrine of Pneumatism to the
science of medicine, Athenaeus maintained that the
majority of diseases owed their origin to some disturbance
or disorder of the spirit; but it is almost impossible to
understand, from the scanty data which have come down
to us, what Athenaeus really meant by the term "spirit,"
and by the expression "disorder of the spirit."

142 GROWTH OF MEDICINE

From the definition which he gives of the word ** pulse" one is
justified in drawing the conclusion that he considered the spirit
to be an actual substance, capable of undergoing, to a greater or
less degree, such changes as expansion and contraction. The same
obscurity of meaning is encountered when one endeavors to dis-
cover how the new doctrine affected the practice of medicine.
(Le Clerc.)

In view of all these circumstances it is not at all sur-
prising that Pneumatism was not very popular with the
physicians of Rome, and that, after a brief period had
elapsed, many of the adherents of this doctrine abandoned
it and gave their preference to the more practical teachings
of the Methodists. Meyer-Steineg goes so far as to remark
that, to all intents and purposes, such a thing as a sect of
Pneumatists did not exist.

The most prominent of the disciples of Athenaeus were
Theodorus, Agathinus, Herodotus, Magnus and Archigenes.

Haller speaks of Theodorus as the inventor of a remedy
which, as he claimed, cures all cases of poisoning.

The Eclectics. — Agathinus, a native of Sparta, was
the teacher of Herodotus and Archigenes. His chief
distinction is to be found in the fact that he gave to the
offshoot from the school of the Pneumatists the name of
"Eclectics,"^ his object being, as we are assured by
Neuburger, to bring the three sects (Pneumatists, Empirics
and Methodists) into closer union.

Herodotus — who, it is perhaps desirable to state, is a
different person from the famous historical writer of the
same name — lived during the latter part of the first century
A. D., and was more closely allied to the Methodists than
to the Pneumatists. It appears from the text of a fragment
of one of his treatises that he wrote a description of the
disease now called small-pox and directed attention to its
contagious character.

Magnus, a native of Ephesus in Asia Minor, is reported

1 Le Clerc calls attention to the incorrectness — etymologically speaking — of
the use of the word "Eclectics" in connection with a school or sect. The
members of such a body are not, he says, "the chosen ones" as the term
signifies, but "the choosers."

HISTORY OF METHODISM AT ROME 143

to have been the writer of a collection of letters on medical
topics and also of a history of the discoveries made in
medicine subsequently to the time of Themison.

Archigenes, the fifth member of this group of Pneu-
matists, was born in Apamea, Syria, and lived in Rome
under the reigns of Trajan (98-117 A. D.) and Hadrian
(117-138 A. D.). Le Clerc speaks of him as belonging to
the Eclectics rather than to the Pneumatists. This is a
matter, however, of small importance, as the sects were,
at that period, very much mixed. The poet Juvenal, who
was a contemporary of Archigenes, refers to him briefly
as a physician who had a large practice ; and the historian
Suidas says that he wrote a great deal about physics as
well as about medicine. That he was esteemed highly as
an authority in practical surgery is shown by the fact that
Galen, when he discusses surgical topics, makes frequent
quotations from the writings of Archigenes. Only frag-
ments of the latter, however, have come down to our time.
His popularity as a practitioner was very great; notwith-
standing which he managed to write several treatises on a
variety of topics — on the pulse, on feverish diseases, on
the different types of fevers, on local affections, on the
diagnosis and treatment of acute and chronic maladies,
on the right moment when surgical operations should be
performed, on drugs, and on therapeutic procedures in
general. He applied ligatures to blood-vessels and also
arrested further bleeding from them by passing needles
through the adjacent parts in such a manner as to exert
pressure upon the vessel (a procedure which is termed
** acupressure ") ; he operated for the removal of both
mammary and uterine cancers; he employed the red-hot
cautery iron for the arrest of hemorrhage and also for the
relief of coxalgia, and he was familiar with the use of the
vaginal speculum.

Antyllus, another prominent surgeon of that period,
joined the Methodists at a considerably later date. He
was also the author of an excellent treatise on surgery, the
greater part of which, unfortunately, has been lost or
destroyed.

144 GROWTH OF MEDICINE

Aretaeus of Cappadocia, a district of Asia Minor, lived
during the second century A. D. He was a man of very-
broad culture. From the fact that he assigned an important
role to the pneuma, he is usually classed among the
Pneumatists. He does not appear, however, to have taken
a very active interest in the doctrines of that school, and
both Le Clerc and Daremberg seem disposed to call him
an Eclectic, and we may therefore rank him as one of the
independent physicians of that period. It is doubtful
whether he ever practiced in Rome. His two treatises —
one on the causes and means of identifying acute and
chronic diseases, and the other on the treatment of these
diseases — are written in Greek, and are characterized by
the clearness and simplicity of his descriptions, which very
closely resemble those of Hippocrates, and by the soundness
of the advice which he gives in regard to the methods of
treatment.^ In his conceptions of what a physician should
aim to be, Aretaeus maintained a very high standard.
Some of his views regarding human physiology and
pathology are given here very briefly: Respiration serves
the purpose of cooling the warmth of the heart, and the
lungs are therefore prompted by the latter organ to draw
cool air into their cavities; digestion takes place not only
in the stomach but also in the intestinal canal, and owes its
origin to warmth; the cerebral nerves, close to the spot
from which they originate, cross from one side to the other,
and by the aid of this fact paralysis on one side of the body
may be explained. Aretaeus has gained considerable fame,
says Puschmann, from his description of the ''Syriac
ulcer," the picture of which he draws agreeing perfectly
with what is known to-day as pharyngeal diphtheria. In
various places throughout his writings he displays a
thorough knowledge of normal anatomy — as, for example,
when he describes the ramifications of the vena portae and
gall-ducts of the liver. He was also well informed in
matters belonging to the domain of pathology, for he gives

2 Boerhaave, the famous clinician of Leyden, Holland (eighteenth century),
was instrumental in having an excellent Latin translation made of this work;
and in 1858 a German translation by A. Mann was published in Halle.

HISTORY OF METHODISM AT ROME 145

admirable descriptions of many of the diseases — for
example, pleurisy with empyema, pneumonia, pulmonary
consumption, cerebral apoplexy, paraplegia, tetanus,
epilepsy, diabetes mellitus, gout, etc. From the character
of these descriptions one is strongly tempted to believe
that he must have made a certain number of postmortem
examinations.

According to Neuburger, Aretaeus enters very fully into
details when he discusses the subject of diagnosis; his
statements in one place warranting the belief that he even
auscultated the heart. His methods of treatment were
based largely upon his own experience and were generally
of a simple character. He attached great importance, for
example, to a very careful regulation of the diet, muscular
exercise, massage, etc., and his employment of remedies
was confined to a very small number of such drugs as exert
a mild action. When the case, however, was of such a
character as to call for more vigorous interference, he did
not hesitate to resort to the use of opium, emetics,
cathartics, venesection, blistering, the red-hot cautery
iron, etc.

Rufus, a native of Ephesus, a city of Asia Minor, about
thirty-five miles from Smyrna, is reckoned by most authori-
ties among the Eclectics; in other words, he was an
independent, or one who adopted from the teachings of
the different sects such doctrines as met with his approval,
but who, at the same time, did not care to pose as the
disciple of any one of them. He received his medical
training at Alexandria, but it is not known where he
practiced his profession. Almost no details concerning his
life or his professional career have come down to our time.
It is simply known that he flourished during the reign of
the Emperor Trajan (98-117 A. D.). Ebn Ali, an Arabian
physician and author, says that he was the leading medical
authority of his time and that his works were highly
esteemed by Galen. His treatise on anatomy (entitled
**The Names of the Different Parts of the Human Body"),
which is one of the few that have escaped destruction, is
described as a treatise which was written for students, and

146 GROWTH OF MEDICINE

which possesses great value for the history of anatomical
nomenclature. The same authority says that Eufus was
the first to describe the chiasma, that he came very near
establishing the existence of two different kinds of nerves —
motor and sensory — and that he attributed the control of
all bodily functions to the nervous system. He also states
that he was one of the first to furnish a description of the
oriental bubonic plague. Some idea of Eufus' style of
writing may be gathered from the following quotations
which have been taken from his short treatise entitled
**The Questioning of Patients": — ^

It is necessary to question the patient, for by so doing one may
gather more exact information concerning the nature of the malady,
and will then be able to treat it more intelligently. In this way
also one may learn whether the patient's mind is in a normal or
an excited state, and whether any change has taken place in his
physical strength. Some idea regarding the nature and seat of
the disease is usually obtained from such questioning. If, for
example, the patient answers clearly and to the point, and does
not hesitate ; if his memory does not play him false ; if his speech
is not thick or indistinct; if, being a well-bred man, he gives his
responses in a polite and cultivated manner; or if, in the case of
a person who is naturally timid, the answers reflect this timidity,
then you may feel confident that your patient 's mind is not affected.
But if, on the other hand, you ask him about one thing and he gives
you a reply about something entirely different; if, as he talks, he
appears to forget what he was talking about ; if he has a trembling
tongue the movements of which are also uncertain; and, finally,
if from a certain state of mind he passes rapidly to one of a totally
different character, — all these changes are evidences that the brain

is beginning to be affected If the patient speaks distinctly

and with a fairly strong voice, and is able to tell his story
without stopping from time to time in order to rest, the
inference is warranted that his physical strength is not materially
affected

The following quotation is from his treatise on gout: —

If the patient complains that one of his joints is painful, he
should be asked whether or not the part has received a blow. If

3 Translated from Oeuvres de Bufus d'£phdse; Edition Grecque et Fran-
(jaise, par Daremberg et Euelle, Paris, 1879.

HISTORY OF METHODISM AT ROME 147

he replies that it has not, then (you may infer that the pain is due
to gout and) you should forthwith put him on a suitable diet,
order a clyster and bleed him at a spot not far (from the seat of

the pain) The withdrawal of nourishment is ordered for

the purpose of arresting any further formation of new blood and
thus preventing the joints from growing more sluggish in their
movements. The clyster is ordered because we believe that it is
beneficial (in this condition) to evacuate the bowels. The bleeding
will be found useful, but to a less degree in the loAver than in the

upper limbs One must be careful not to assume that the

patient is cured when he has been entirely relieved of his pain,
because with the lapse of time fresh attacks are liable to occur;
this disease, like certain other affections, possesses a periodic
character Therefore it is well, immediately after the blood-
letting, to employ friction, to get rid of the excess of moisture in
the body by some laborious form of exercise, to take such articles
of food as are easily digested, — in brief, to aim chiefly at reducing
as much as possible the moisture of the body.

One cannot but feel a keen regret that so few of the
writings of this thoroughly practical and highly educated
physician should have come down to our time. So far as
I am able to learn, Rufus wrote no fewer than 102
treatises, all of which, with the exception of the seven
about to be mentioned (together with a number of frag-
ments preserved by different writers of antiquity) have
either disappeared or been destroyed. The titles of the
treatises which have been preserved are as follows:
(1) Diseases of the Kidneys and Bladder; (2) On Satyriasis
and Gonorrhoea; (3) Purgatives; (4) The Names of the
Different Parts of the Human Body; (5) On the Ques-
tioning of Patients; (6) On the Pulse; (7) On Gout.

A General Survey of the Subject of Sects in Medicine. —
During the sixth century B. C, — that is, about two hundred
years before the formation of the more distinctly medical
sects of which mention was made in Chapter IX., —
Pythagoras of Samos and his disciples put forward
certain beliefs or doctrines with regard to the mode of
action of some of the functions or vital processes of the
human body, and all those who accepted these teachings
as affording a true and satisfactory explanation of the

148 GROWTH OF MEDICINE

phenomena in question constituted what is generally
termed a school or sect. Some of these individuals were
physicians — that is, men who undertook to cure or at least
to relieve those who were ill; but probably the majority
were simply philosophers, mere 'Covers of wisdom," who
by studying problems of this nature sought to satisfy their
longing for a more perfect knowledge of the truth respect-
ing the various phenomena of life.

A few years later, Heraclitus of Ephesus, who, like
Pythagoras, was both a philosopher and a practicing
physician, taught the doctrine that all things owe their
origin to fire. One is not at all surprised to learn that
he had relatively few followers, for history tells us that
he was both a misanthrope and a slanderer of the medical
profession, as shown by the following saying which is
attributed to him: ''Next to physicians the grammarians
are the biggest fools in the world."

Hippocrates attached much importance to the value of
experience and to the necessity of studying disease at the
bedside; at the same time he upheld what is commonly
known by the name of humoral pathology — a doctrine which
refers all maladies to some abnormal change in the humors
or fluid portions of the body. His writings also show that
he made full use of the reasoning power. The followers
of this great physician did not form a sect in the ordinary
sense of the term ; they were his adherents simply because
he was an able diagnostician, a successful teacher, an
excellent therapeutist, a skilful surgeon, a man of very
high moral character, — in short, a great physician. Every
sect which developed in the centuries following his death
contained a goodly proportion of Hippocratists.

Nearly two centuries after the active period of the
professional life of Hippocrates, Erasistratus and Hero-
philus gathered about themselves in Alexandria (about
280 B. C.) large groups of followers, who held for their
respective teachers a degree of esteem which amounted,
according to Galen, almost to veneration. As there was
little or no antagonism or lack of harmony between the
doctrines taught by these physicians, the two groups can-

HISTORY OF METHODISM AT ROME 149

not properly be classified among the sects. In fact, it would
be more correct to say that Erasistratus and Herophilus
contributed facts of permanent value to our stock of
knowledge rather than doctrines which might prove highly
popular for a few scores of years, but which would prob-
ably in due course of time be set aside as no longer of value.

The four most characteristic types of sects in medicine
were the following: the Dogmatists — or Rationalists, as
Daremberg calls them in one place ; their great rivals, the
Empirics; the Methodists; and the Eclectics. The oldest
sect, the Dogmatists, did not come into prominence until
after the medical schools at Alexandria had already been
in operation for a long time. The development of the rival
sect of the Empirics at this late period brought with it
endless discussions regarding the merits of their respective
teachings, and thus both of them gained a degree of promi-
nence which seems to us moderns to have been out of all
proportion to the importance of the subject-matters dis-
cussed. The Dogmatists, says one writer, insisted that it
is just as necessary to be acquainted with the ''hidden
causes ' ' of disease as with those which are plainly recogni-
zable, and that it is only by aid of the reasoning power
that we gain some knowledge of this class of causes. They
claimed that, while a knowledge of anatomy is of very
great service to the surgeon, it usually renders this service
through the aid of the reasoning power; as when, in the
performance of a lithotomy, the operator selects the fleshy
{i.e., vascular) neck of the bladder as the spot in which to
make the opening with the knife, in preference to the base
of the organ, which is chiefly membranous in structure and
therefore less likely to heal solidly.

The plausible but rather shallow response made by the
Empirics to the arguments advanced by their rivals con-
sisted in quoting certain maxims, as, for example : * * The
farmer and the helmsman do not acquire knowledge of
their respective occupations from discussions, but from
actual practice"; **It is not of vital importance to know
what are the causes of the different diseases, but what

150 GROWTH OF MEDICINE

remedies are competent to cure them"; and "Diseases are
not cured by eloquence, but by remedial agents,"

Among the comments made by Celsus with regard to
the differences which distinguished the Dogmatists from
the Empirics we find the following statement: *'The two
sects employed the same remedies and pursued very much
the same course of treatment, but their reasonings about
such matters were different."

Modern physicians will, at first thought, be disposed to
wonder how men as clever as many of these physicians
were could have split up into separate and more or less
antagonistic sects because of such apparently trivial
differences of opinion. It must be remembered, however,
that these men were groping in comparative darkness
whenever they tried to advance their knowledge of path-
ology, and that in this imperfect light many things seemed
of much greater importance than they appeared to be in
the brighter light of later centuries. It is only fair, there-
fore, to withhold criticism and to ask ourselves whether
this strong desire on the part of those men to advance
their knowledge of pathology — a desire which manifested
itself in the formation of sects — was not in reality an
evidence of the great vitality of Greek medicine on Eoman
soil in those early centuries.

The remarks made above with regard to the Dogmatists
and the Empirics apply in a general manner to the sects
known as the Methodists and the Eclectics, a sufficiently
full account of which has been given in the preceding
chapter.*

4 The term ' * dogmatists ' ' is also employed by some authorities to designate
those physicians who laid great stress upon the importance of following the
teachings of Hippocrates and Galen.

CHAPTER XIV

WELL-KNOWN MEDICAL AUTHORS OF THE
EARLY CENTURIES OF THE CHRISTIAN ERA

There were four men who were not especially identified
with any of the sects described in the preceding chapters,
and yet who occupied, as authors of medical treatises, very
prominent places in the history of medicine of the period
or epoch which we have just been considering. They are
Celsus, Scribonius Largus, Pliny the Elder and Dioscori-
des. These men lived during the first and second centuries
A. D. and they therefore all belong strictly to the period
which is designated in our scheme as the fourth epoch.
I shall give here brief sketches of all of these writers and
of their works. While Caelius Aurelianus, another impor-
tant medical author, belonged to a much later period, I shall,
for reasons of convenience, describe in the same chapter
with the others the part which he played in the evolution
of medicine.

Aulus Cornelius Celsus, called by some the Latin Hip-
pocrates and by others the Cicero of physicians because
of the correctness and elegance of his Latin and the clear
manner in which he puts his thoughts into words, flour-
ished during the reign of the Emperor Augustus (27 B. C-
14 A. D. ) . The date and place of his birth are not known,
but it is generally believed that he was born and received
his education at Rome. The great work which he wrote
and upon which he must have been engaged the larger part
of his lifetime was a sort of cyclopaedia, which bore the
title ^^Artium libri,'* and in which each department of
knowledge was represented by a separate treatise. It is
said that five books were devoted to agriculture, seven to
rhetoric, eight to medicine, etc. ; but all of these treatises.

152 GROWTH OF MEDICINE

excepting those relating to the latter science, have been
lost or destroyed. It is not certainly known to which of
the professions Celsus belonged, but the very skilful and
judicious manner in which he has culled all that is best from
the medical treatises published before his time, the remark-
able knowledge of technical details which he displays in
every part of his own work, and the fine tone of medical
thought which pervades these eight books, almost compel
the conclusion that the author was a very clever clinician,
although probably not a physician who practiced for a
money reward. In no other published treatise is a more
perfect picture of the medical practice of antiquity to be
found than that which Celsus gives us in his work ^^De arte
medica libri octo."

It is not an easy matter to select, from a treatise of
several hundred pages in length, one or two passages of
such a character that they may be accepted as fairly repre-
senting the author's manner of dealing with medical and
surgical questions of practical interest. The two given
below are translations from Vedrenes' version (Paris,
1876), and they deal, the one with venesection and the other
with the proper manner of arresting hemorrhage from a
wound. Both the passages quoted represent only frag-
ments, as sufficient space for more extensive extracts is not
available.

Book II., Chapter X. — Bloodletting from a Vein. — Incising a
vein for the purpose of drawing blood from it, is not a new pro-
cedure ; but it is certainly a new thing to resort to bloodletting in
almost all diseases. Again, it is an ancient custom to employ
bloodletting in young subjects and in women who are not preg-
nant, but it is a new thing to perform this operation on infants
and aged individuals, and on women approaching the period of
confinement. It was the idea of the ancients that persons at the
two extremes of life were not able to support this sort of treatment,
and they were convinced that a pregnant woman, if subjected to
the operation of bloodletting, would almost surely be confined
before the completion of her time. Since then, however, experience
has shown that there is no fixed rule about this matter, and that
a physician should preferably regulate his course in accordance
with observations of a different nature. The determining factor,

EARLY MEDICAL AUTHORS 153

for instance, is neither the age nor the pregnant state of the patient,
but rather the degree of physical strength. In the case of a youth
who is feeble, or of a delicate woman (aside from the question of
pregnancy), it would be wrong to draw blood, for it would be
robbing them of what little strength they possessed. But, in the
case of a vigorous child, a robust old man, or a pregnant woman
who is in good health, one need not hesitate to resort to this pro-
cedure. Nevertheless, there may arise, in connection with the
operation of venesection, a number of questions which are quite
likely to puzzle an inexperienced physician and perhaps lead him
into error. For example, infants and old people possess as a rule
diminished vigor, and the woman who is about to be confined needs
all her strength for the period following delivery, both for herself
and for the nourishing of the child. But the mere fact that one
must give some thought to questions of this nature and must exer-
cise prudence does not justify the immediate rejection of a method
of treatment like that of venesection. For is it not the very essence
of our art, not merely to consider the factors of age and the
pregnant state, but also to form an estimate of that other and
more important factor, viz., the patient 's strength, — be that patient
an infant, an aged person, or a woman advanced in pregnancy, —
and then to decide whether it is, or is not, great enough to bear
the loss of blood? In deciding a question of this kind it will be
necessary to distinguish between real vigor and obesity, between
thinness and feebleness, etc.

Venesection is an easy operation for a physician who has already
familiarized himself with the manner of performing it, but for one
who is ignorant of these details it may prove very difficult. It is
necessary, for example, to bear in mind that the artery and vein
are united and that they are accompanied by nerves ; and, further,
that the injuring of the latter will induce spasms and violent pains.
On the other hand, it must also not be forgotten that an artery
once opened has no disposition to close, nor does it heal, and that
sometimes the blood escapes in an impetuous manner. If, per-
chance, the vein is cut transversely, the edges of the opening con-
tract and no more blood escapes. Again, if the scalpel is plunged
into the parts timidly, the skin alone will be divided and the vein
will not be opened. In some cases this vessel is so hidden from
sight that the physician may experience difficulty in bringing it
into view. Thus it will be seen that there are several circumstances
which may render this operation difficult for an ignorant or inex-

154 GROWTH OF MEDICINE

perienced physician. The vein should be incised in a longitudinal
direction, midway between its two sides. The moment the blood
gushes from the opening its color and general appearance should
be carefully noted, etc.

Book v.. Chapter XXYI. — The Proper Manner of Arresting
Hemorrhage from a Wound. — If there is fear that there may be
bleeding, one should fill the wound with dry lint, place over it a
sponge wrung out of cold water, and press upon it with the hand.
If the bleeding still continues, it is advisable to change the stuffing
of lint somewhat frequently; and, if this step proves ineffective,
then lint moistened with vinegar may be tried, for this liquid
acts energetically in arresting hemorrhage. Some physicians, in-
deed, actually pour it into the wound. There is a strong objection,
however, to the use of an agent which, like vinegar, arrests the
bleeding too completely — viz., that it is apt to set up afterwards
an intense inflammation of the parts. The same reasoning applies
with even greater force to the employment of corrosives and caus-
tics, which produce an eschar. Despite the effectiveness of most of
these in arresting hemorrhage, their use should be discouraged.

Finally, if the bleeding continues it will be necessary to

grasp the vessel from which the blood is escaping, to ligature it
in two places close to the wound, and then to divide the vessel
between the two ligatures, in order that it may retract (both of
the new orifices having already been closed by the ligatures). If
the circumstances are such that the plan just recommended can-
not be carried out, it will then be advisable to apply the red-hot
cautery to the bleeding vessel. When a rather free hemorrhage
occurs at a part of the body where there are no nerve trunks and
no muscles, — as on the forehead or at the top of the head, — the
simplest plan is to apply a cup at some little distance from the
source of the bleeding and thus divert the current of the blood
from the spot affected.

And to these two longer extracts may be added a third : —

From these considerations the inference is warranted that a
physician cannot possibly give proper attention to a large number
of patients. (Book III., Chapter IV.)

Celsus' treatise was ignored by physicians for many
centuries, but it was considered by the monks, in the Mid-
dle Ages, a valuable guide in the treatment of disease ; and
it was probably owing to this circumstance, says Vedrenes,

EARLY MEDICAL AUTHORS 155

that the book did not altogether disappear. It was not
until the year 1443 that Thomas de Sazanne, afterward
Pope Nicholas V., discovered a copy of the work in the
church of Saint Ambrosius, at Milan, but it was only in
1478 that the book was printed for the first time (at Flor-
ence). Then, as if to make up for the long neglect to which
it had been subjected, no fewer than sixty Latin editions
were issued during the two succeeding centuries; and, in
addition, it was eventually translated into every modern
European language.

Scribonius Largus, a Roman physician who lived dur-
ing the reigns of Tiberius and Claudius (14-54 A. D.), owes
his celebrity to the fact that he wrote and published (in 47
A. D.) a book containing a collection of the best medical
formulae and popular recipes known at that time. He ap-
pears to have had a large private practice and to have
spent a considerable portion of his professional life in the
service of the army. He accompanied the Emperor
Claudius, for example, in his campaign against Britain
(43 A. D.), and the book which he wrote, and which has just
been mentioned, was dedicated by him to that emperor.
According to Neuburger, Scribonius is to be credited with
having been the first to describe correctly the proper manner
of obtaining the drug known as opium, and also the first
to recommend, in the treatment of severe headaches, the
employment of electric shocks as communicated by the fish
called the ** electric ray."

Medical practice at that period, says Le Clerc, was
divided among three kinds of practitioners — those who
treated their cases exclusively by dietetic measures, those
who effected cures by surgical means, and those who took
charge only of such patients as required chiefly the employ-
ment of external remedies. But Scribonius Largus insists
that such a division was more theoretical than real, as
no one of these classes could get along without the co-
operation of the others.

C. Plinius Secundus, commonly called Pliny the Elder,
was born near the beginning of the first century of the
Christian era, either at Verona or at Como in the north

156 GROWTH OF MEDICINE

of Italy, and settled in Eome at an early period of his life.
At the beginning of his career he served for some time in
the army in Germany, and upon his return to Eome prac-
ticed as a pleader. Subsequently he held various official
positions which gave him the opportunity of visiting other
countries of Europe. He perished at Stabiae (near the
modern Castellamare, on the Gulf of Naples) in 79 A. D.,
at the age of fifty-six years, while watching the eruption of
Vesuvius, which overwhelmed Herculaneum and Pompeii.
He was in command of the Roman fleet at the time.

Pliny was indefatigable as a writer and as a gatherer
of knowledge of all sorts, and he and Celsus are well named
the Encyclopaedists. He is said to have written twenty
books on the war with the Germans, an unknown number
on rhetoric and grammar, and thirty-seven on natural his-
tory. The latter books alone have come down to our time.
Pliny's nephew, who is known as Pliny the Younger, and
who edited the great work of his uncle on natural history,
furnishes us, in a letter addressed to the historian Taci-
tus, with some interesting details regarding the elder
Pliny's manner of life. It appears from this account, that
the latter read almost incessantly. During his meals and
while he was taking his bath, an attendant read aloud to
him. He also took his books with him on his travels and
was always accompanied by a person who could write rap-
idly under dictation. He continued this practice upon his
return to Rome and dictated to his amanuensis even while
he was being carried about in a sedan chair. Books 20-
27 of his great work on natural history are devoted to the
subject of remedial agents belonging to the vegetable king-
dom, books 28-32 deal with those which belong to the ani-
mal kingdom, and books 33-37 treat of mineralogy with
special reference to medicine, painting and sculpture.
Pliny was a compiler and not an original investigator.
Some idea of the popularity of his treatise on natural his-
tory may be gathered from the fact that it was the second
book to be printed after the invention of printing, the Bible
being the first. Another interesting fact connected with
Pliny's treatise is mentioned by Neuburger, viz., that the

EARLY MEDICAL AUTHORS 157

use of hyoscyamus and belladonna as agents capable of
dilating the pupils, owed its origin to the discovery (by C.
Himly, in 1800) of a place in the text (Book XXV., 92)
where it is stated that the juice of the plant Anagallis was
rubbed into the eyes before the operation for cataract was
undertaken.

According to Pliny (Book XXXL, Chapter VI.), the
ancients employed mineral waters extensively in the form
of baths, and they also occasionally used them as internal
remedies. Galen, too, mentions the fact that these waters
were in demand in the spring or autumn for purgative pur-
poses.

In Book XXXIX., 8, 3, Pliny — as quoted by Vedrenes —
makes the following remarks : —

Very few Romans have shown an active interest in medical affairs,
and those few speedily found it necessary to pass themselves off as
Greeks. For it is a well-known fact that those physicians who,
without being able to speak Greek, attempted to build up a prac-
tice in Rome, failed to gain the confidence of their patients, even

of those who were not at all familiar with that language

When one's health is the question at issue the readiness to place
confidence in a medical adviser is apt to diminish in proportion
as one's knowledge of the man increases. Indeed, medicine is the
only art in which one is quite ready at first to put faith in almost
anybody who calls himself a physician, and that too, despite the
acknowledged fact that in no other circumstances of life is an
imposture more fraught with danger.

English versions of Pliny's Natural History and of
Pliny the Younger 's Letters have been published in what
is known as Bohn's Libraries.

Pedanius Dioscorides, a native of Anazarba, a small
Greek town near Tarsus in Cilicia, lived about the middle
of the first century A. D. (during the reigns of Nero and
Vespasian). From his earliest youth he took a great in-
terest in botany, and, after reaching manhood, traveled
extensively in the wake of different Roman armies, for
the sole purpose of studying by direct observation the
plants of different countries and of verifying the medicinal
virtues which each one was reputed to possess. In this

158 GROWTH OF MEDICINE

way lie visited, in turn, Greece, Italy, Asia Minor and per-
haps also the southern portion of France (the Narbonaise).
He collected great quantities of specimens of every kind
of drug — animal and mineral substances as well as objects
belonging to the vegetable kingdom; and, wherever it was
possible to do so, he wrote memoranda of the traditions
of the natives with regard to the uses and medicinal effects
of these different drugs. After he had completed all these
researches and had gathered together all this vast mass of
materials, he wrote his famous treatise on materia med-
ica — 'Hhe most complete, the best considered, and the
most useful work of its kind to be found anywhere to-day."
(Galen.) It is from this treatise, therefore, says Dezei-
meris, that one can derive the most satisfactory idea of
the early Greek materia medica ; but at the same time, he
adds, it is not a book in which will be found a detailed
account of the manner in which the practitioners of that
period employed the remedies which he describes. The
same authority calls attention to the great difficulty which
modern physicians often experience in their attempts to
identify the drugs which Dioscorides describes. Le Clerc
calls attention to the fact that the physicians who were
contemporaries of Dioscorides were not in the habit of
employing either iron or antimony (called by them stibium)
internally. Apparently they had not yet learned that these
substances possess properties which exert a curative action
in certain diseases. On the other hand, he mentions the
manner of extracting quicksilver, by chemical means, from
cinnabar [red sulphide of mercury], the steps required
for preparing acetate of lead, and the proper way of mak-
ing lime water.

The work to which reference has been made above was
published by Dioscorides about the year 77 A. D. It is
the earliest pharmacological treatise that has come down
to our time, and for many succeeding centuries it served
as the authoritative guide in all questions relating to drugs.
The first printed edition of the Greek original appeared in
Venice in 1499, but a still earlier Latin version was issued
in 1478. According to Pagel the best edition (in Latin and

EARLY MEDICAL AUTHORS 159

fully illustrated) is that of Pietro Andrea Mattioli, which
was printed in Venice in 1554. Neuburger commends
highly the German version by J. Berendes. (Stuttgart,
1902.)

Of Caelius Aurelianus we possess no biographical de-
tails beyond the facts that he was a native of Sicca in
Numidia, Africa, and that he lived toward the end of the
fourth or during the first part of the fifth century of the
present era. He was the author of several works, all but
one of which, however, have been lost. The single treatise
which has come down to our time treats of acute and
chronic diseases, and is spoken of by Daremberg as being
virtually a translation of one of the lost writings of Sora-
nus. This book, says Haeser in his History of Medicine,
is the most important source from which our knowledge
of Methodism is derived; and Neuburger not only agrees
with this statement, but adds that the treatise of Caelius
Aurelianus played a most important part, toward the end
of the Middle Ages, in the evolution of medicine. Up to
the present time no translation of this work into any mod-
ern language has been published, but Neuburger furnishes
a very full analysis of its important parts. In two places,
as appears from this analysis, Caelius Aurelianus men-
tions— among the signs and symptoms of certain affections
of the respiratory apparatus — phenomena which show
beyond a doubt that he (or Soranus) was familiar with
auscultation of the chest. The words which he uses are
these : —

''Stridor vel sonitus interius resonans aut sihilans in ea
parte quae patitur," and '' sihilatus vehemens atque asper
in ultimo etiam pectoris resonans stridor."

CHAPTER XV

CLAUDIUS GALEN

During the centuries immediately preceding the Chris-
tian era, Greek medicine was represented by a collection
of treatises which had been written by Hippocrates and his
followers on anatomical, physiological, pathological, thera-
peutical and ethical subjects, and which constituted a fairly
complete but not always easily intelligible system. As
time went on, however, and especially as new and useful
facts were constantly being added to the existing stock of
medical knowledge, the more thoughtful physicians began
to feel that the system, which up to that day had proved
acceptable, needed to be perfected in a number of respects ;
and accordingly, as a result of this feeling of dissatisfac-
tion, and also as an expression of the prevailing desire
for a more perfect knowledge of the truth, there developed,
as has been stated in the preceding chapters, a number of
different medical sects. When Galen first appeared in the
field as a physician of unusual promise, these various sects
were all still in a thriving condition. The Methodists, in
particular, were very popular. Galen did not favor any
special sect, but in his writings he made it manifest that
he attached more importance to the teachings of Hip-
pocrates than to those of any other author. ''It was Hip-
pocrates," he said, ''who laid the real foundations of the
science of medicine." It is therefore not surprising that
Galen should have devoted so much time to the writing of
elaborate commentaries on the works of Hippocrates. The
service which he thus rendered to medicine, says Darem-
berg, was of very great value. But Galen, notwithstanding
his great admiration for Hippocrates, did not hesitate to

^

CLAUDIUS GALEN 161

criticise a number of his teachings, and especially those
which, as he believed, were not stated with sufficient clear-
ness. Valuable as was the service rendered to medicine by
the writing of these commentaries, there still remained an
urgent need for a service of a different and much more
difficult kind, viz., that of welding together into a single
clearly written and easily intelligible system of medicine,
all that was good in the Hippocratic writings and in the
disconnected and at times antagonistic teachings of the
sects. To accomplish this successfully required the ser-
vices of a man endowed with mental gifts of a most excep-
tional character — complete knowledge of medicine in all
its departments, a mind thoroughly trained in philosophy,
the power to express his thoughts in simple language, and ijji

an independence and fairness of judgment which would
render him indifferent to the petty interests of the sects.
Claudius Galen, as subsequent events showed, possessed
these very gifts in a high degree, and he devoted the better
part of his reasonably long lifetime to the accomplishment
of this much-needed work. How greatly it was needed at
that particular period of time, nobody then knew or could
even suspect. It soon appeared, however, that all the
vaunted civilization of the Graeco-Roman world — ^much of
it of the purest gold and a great deal of the basest alloy —
was to be swept so completely off the face of the earth that,
for thirteen hundred or more years, almost no thought
whatever could possibly be given to the science and art of
medicine. Fortunate, most fortunate it was, therefore,
that, before this wave of destruction reached Rome, all the
best part of Greek medical literature — for such it was in
truth — had been gathered together and carefully systema-
tized by Galen and stowed away in the recesses and cham-
bers of remotely situated monasteries and churches by
clear-sighted monks for the benefit of later generations of
physicians.

Brief Biographical Sketch. — Claudius Galen was born
in Pergamum, an important Greek city of Asia Minor,
about the year 131 A. D., under the reign of the Emperor
Hadrian. His father, whose name was Nicon, was a man

*i

162 GROWTH OF MEDICINE

of ample means, well informed in philosophy, astronomy
and geometry, and most liberal in providing for the thor-
ough education of his son in every branch of useful knowl-
edge. In two or three places in his writings Galen speaks
of his father in terms of affection. On the other hand, he
does not hesitate to state in the plainest language possible
that his mother was a veritable Xanthippe. In her mo-
ments of bad temper she would not only shout and
scream in a violent manner, but would sometimes go so
far as to bite her serving-maids. Pergamum, at the time
of which I am writing, offered unusually good opportu-
nities for studying disease. Its Asclepieion, which was
built during Galen's boyhood, had already become one of
the famous temples of Asia Minor, and the sick and maimed
flocked to it in large numbers. Then, in addition, the city
was well equipped with able physicians, who appear, ac-
cording to Neuburger, to have been on very friendly
terms with the priests of the temple. It was under the
guidance of such men that Galen — at the early age of
seventeen, and after a careful training in philosophy,
mathematics, etc. — began the study of medicine. He speaks
with special interest and respect of one of his instructors,
a certain Quintus, who had the reputation of being an ex-
cellent anatomist and at the same time one of the most dis-
tinguished practitioners of that day. Another anatomist,
Styrus, was also one of Galen's teachers.

On the death of his father Galen left his home and de-
voted the succeeding nine years to visiting all the differ-
ent cities in which he believed he might gain some addi-
tional knowledge in medicine and surgery. A large part
of this long period was spent in Alexandria, which still
retained much of its importance as a home of all the sci-
ences. On attaining his twenty-eighth year he left that
city and returned to Pergamum, evidently with the pur-
pose of establishing himself there in the regular practice
of his profession. Through the influence of the temple offi-
cials, and especially of the High Priest, Galen received the
appointment of physician to the gladiators, a position
which he held with credit for a period of four years, and

CLAUDIUS GALEN 163

which afforded him excellent opportunities for cultivating
his knowledge of surgery. It was while he was serving
in this capacity that he devised and put into practice
a method of saturating the dressings (in cases of severe
wounds) with red wine, for the purpose of preventing the
development of inflammation in the parts affected ; and the
success which he thus obtained was so great that not one
of the gladiators intrusted to his care died from his
wounds. History does not state the precise manner in
which Galen carried out his method of utilizing wine in the
dressing of wounds, and we are therefore unable to deter-
mine just how much credit he was entitled to receive for
this crude but apparently effective means of securing local
antisepsis. It is clear, however, that Galen's treatment
could only have been a modification of a much older method,
for Jesus, in his answer to a question put to him by a
lawyer, said : * ' But a certain Samaritan, as he journeyed,
came where he (the injured man) was: and when he saw
him, he had compassion on him, and went to him, and bound
up his wounds, pouring in oil and wine, and set him on his

own beast, " (St. Luke x., 33, 34).

At the end of four years there broke out in Pergamum a
riot which rendered residence there, at least for a certain
length of time, undesirable. Accordingly Galen, who was
now thirty-two years old, and who was probably glad of an
excuse for leaving a place where a physician of his educa-
tion and talents had so few opportunities for gaining dis-
tinction, decided to visit Rome, and — if circumstances ap-
peared to favor the plan — to settle there. His first impres-
sions after arriving in that metropolis were favorable to
the plan of establishing himself there permanently, but at
the end of a few years he became conscious of the growing
hostility of those practitioners who had been for a longer
time than he well established in that city. This hostility
increased as he rose in favor and esteem with people of
position and influence. He had treated skilfully and with
success Eudemus, a peripatetic philosopher of great celeb-
rity, for a quartan fever. He had also cured the wife of
Boethus (a patrician who belonged to the consular class)

164 GROWTH OF MEDICINE

of a serious illness and had received as an expression of
appreciation a gift of four hundred pieces of gold. He
had won the friendship and esteem of such men as Sergius
Paulus, the Praetor; of Barbarus, the uncle of the Em-
peror Lucius; and of Severus, who was at that time
Consul, but who later became Emperor. These very in-
fluential men took an active interest in Galen's scientific
work, having been invited by him on more than one occa-
sion to witness his dissections of apes, — dissections which
he made for the particular purpose of demonstrating the
organs of respiration and of the voice. All these facts soon
became known to Galen's rivals and probably helped to
fan the spark of their envy into a flame; but it is very
doubtful whether he was justified in saying that the ill
feeling thus engendered threatened to end in some act of
personal violence, for which reason he decided to leave
Rome and return to Pergamum. His secret manner of de-
parture, without taking leave of anybody, and the fact
that the Plague was just at that time rapidly approaching
Rome, justify the belief, says Neuburger, that it was not
fear of personal violence at the hands of his jealous rivals
that drove Galen away so mysteriously from the city in
which, in the short space of four or five years, he had won
so great professional success, but an unwillingness to face
his duty, which was, to remain and aid in the approaching
fight against the great destroyer — the Plague. If Galen
had been a simple physician, one of the great body of med-
ical practitioners in Rome, no one would be disposed to
question the justice of the criticism which the distinguished
Viennese historian makes of his decision to abandon that
city at the moment of her distress and peril. But, as a
matter of fact, Galen was not a practitioner of medicine
in the full sense of that term. He treated cases of illness
because in no other way would it be possible for him to
acquire the necessary familiarity with disease ; but, almost
from the very beginning, he seems to have fully realized
that he was destined to devote his time and his energies to
a very different kind of professional work, — ^work which
was urgently needed, which promised to be of very great

CLAUDIUS GALEN 165

value to medical science, and which probably no other
physician then living was competent to do effectively.
Furthermore, he was himself profoundly conscious that the
work in question constituted the main object of his life.
His own words (see his statement with reference to Archi-
genes, on page 174) show this plainly, and the huge mass of
medical treatises which he wrote reveal in the most un-
mistakable manner with what untiring persistency he pur-
sued the path which he believed it was his duty to follow.
It being assumed, then, that such were the motives which
actuated Galen, was it a mistake on his part to conclude
that duty did not require him to remain in Rome? The
question is a difficult one to answer, and I do not feel called
upon to decide it. We do not, however, brand a general
in the army a coward because he endeavors to protect him-
self as much as possible from danger during a battle, that
he may be able, to the very end, to direct the soldiers under
his command. Similarly, was not Galen justified in avoid-
ing every risk which was likely to imperil the performance
of duties which were of far greater value to medicine and
to humanity at large than that of acting as a mere soldier
in the ranks of medical men ?

It seems a great pity that one of the most inspiring fig-
ures in the history of medicine should be represented to
posterity with such a blemish upon his character, and I
have therefore ventured to suggest a possible defense of
Galen's action.

Not very long after he had returned to Pergamum,
Galen was summoned by the Emperors Marcus Aurelius
and Lucius Verus, who were then with the army at Aqui-
leia, a few miles north of the present Trieste, to join them
at that city; and he was, of course, obliged to obey. A
fresh outbreak of the Plague had occurred and there had
already been many fatal cases among the troops. It was
therefore decided by the emperors, almost immediately
after Galen's arrival, to return to Rome with a part of
the army. A start was accordingly made, and the company
had already advanced some distance on their way, when
Lucius Verus died. This unexpected event greatly in-

166 GROWTH OF MEDICINE

creased the difficulties of the return journey, as it was
deemed necessary to carry the remains of the deceased
Emperor back to the imperial city. Thus Galen found
himself once more settled in Rome, this time in the capacity
of private physician to the Emperor Marcus Aurelius and
his sons Commodus and Sextus. The position was ex-
tremely well adapted to the needs of Galen, who, from that
time forward, for a period of several years, had at his
disposal ample time for writing and for conducting his
experimental work in anatomy and physiology, a privilege
of which he appears to have made excellent use. He lived
to be seventy years of age, his death occurring during the
latter part of the reign of Severus, or at the beginning
of that of Caracalla (about 201 A. D.).

All Galen's critics agree that he possessed his full share
of peculiarities, — not to call them by the harsher name of
faults. He was constantly ready, for example, to praise
his own doings and sayings, and he rarely lost an oppor-
tunity of holding up the physicians of Rome to ridicule and
contempt^ He was specially bitter in his criticisms of
Methodism and its adherents — ''the donkeys of Thessa-
lus," as he called them. At the same time, no other physi-
cian of ancient or modern times has manifested to an equal
degree such extraordinary industry as a writer and original
investigator in a great variety of departments of knowl-
edge. Although many of his works have been lost,^ those
which have come down to our time are still very numer-
ous— ' ' a sufficient number, ' ' says Neuburger, ' ' to constitute
a library by themselves." I give here a few of the titles
of these works, in order that the reader may get at least
some idea of the great variety of medical topics which
Galen has discussed in his writings. The more complete
list furnished by Daniel Le Clerc contains nearly two
hundred titles, and yet even this is believed to fall short
of the actual number.

1 The majority of the writings of Galen are reported to have been kept, for
safe preservation, in the Temple of Peace, near the Forum ; and the destruc-
tion of this building by fire, during the latter half of the second century, en-
tailed the loss of all these valuable works.

CLAUDIUS GALEN 167

SELECTED LIST OF THE WOEKS OF GALEN EELATING TO
MEDICINE. (FEOM LE CLEEC.)

Explanation of some of the Ancient Terms Employed by
Hippocrates.

On the Establishment of the Art of Medicine.

Definitions of Medical Terms.

On the Different Sects in Medicine.

Discourse against the Empirics.

On the Importance, for a Physician, of a Thorough training in
Philosophy.

The Physician; or Introduction to Medicine.

The Elements, as taught by Hippocrates. (2 books.)

The Different Temperaments. (3 books.)

On the Nature of Man; Commentaries on two Books of Hip-
pocrates. (2 books.)

The Humors.

Do the Arteries Normally contain Blood ?

On Black Bile.

On the Bones. (For Students in anatomy.)

Dissection of the Vocal Organs.

The Anatomy of the Eyes.

Dissection of the Veins and Arteries.

Dissection of the Nerves.

On the Utility of the Different parts of the Body. (17 books.)

On the Natural Faculties. (3 books.)

The Sentiments of Hippocrates and of Plato. (9 books.)

The Organ of Smell.

The Movements of the Muscles. (2 books.)

The Physiology of Respiration.

On Obesity.

On the Maintenance of Health. (6 books.)

The Characteristics of Different Foods. (3 books.)

Precepts regarding the Diet best suited to the Four Different
Seasons and to Each of the Twelve Months of the Year.

On the Manner of Living best suited to those who Wish to Pre-
serve their Health. (3 books.)

On Habit.

On the Differences between Diseases.

On the Causes of Diseases.

On Marasmus or Consumption.

On the Different Kinds of Fevers. (2 books.)

On Thirst.

168 GROWTH OF MEDICINE

On the Parts of the Body Affected. (6 books.)
The Diseases of Women.
The Different Kinds of Pulse. (16 books.)
The Different Kinds of Urine.
On Critical Days. (3 books.)

Commentaries on the Treatises of Hippocrates. (39 books.)
On the Manner of Treating Different Maladies. (17 books.)
On Venesection. (3 books.)
On the Use of Cups, Leeches and Scarifications.
On Purgatives. (3 books.)
On Colic.
On Jaundice.

On Gout. /

On Stone in the Bladder.
Etc.

The numerous works of Galen, says Pagel, constitute a
complete and very satisfactory encyclopaedia of medicine.
The most available edition of his works in Greek is that
of Karl Gottlob Kiihn of Leipzig (1821-1828; 22 Vols, of
about 1000 pages each). There is scarcely a department
which this great physician has not treated quite fully.
But, unfortunately, the translations into modern languages
are relatively few, and they cover only small portions of
the entire work. That of Daremberg, entitled '^Oeuvres
anatomiques, physiologiques et medicales de Galien, etc.^*
(Paris, 1854-1857; 2 Vols.), is in every way most satis-
factory, and it is from this source that I have made a few
extracts — ^just sufficient to give the reader some idea of
Galen 's style of writing and of his competency to deal with
such subjects as human anatomy and physiology. To
attempt anything like a complete exposition of his views
regarding pathology, therapeutics, hygiene, etc., would
necessitate my devoting more space to this part of the
history of medicine than I can afford to give. To those
who desire to obtain more ample information about
Galen's views regarding pathology and therapeutics I
would recommend a study of Daremberg 's admirable work
and a perusal of the careful analysis made by Neuburger
of certain portions of Galen's text.

Galen's Contributions to Anatomy and Physiology. — ^At

CLAUDIUS GALEN 169

the period of time about which I am now writing, and for
many centuries afterward, there existed among all classes
of the community a very strong prejudice against dissecting
human corpses. And even Galen himself appears to have
shared this prejudice, for, in spite of his intense eagerness
to gain a more perfect knowledge of human anatomy, he
apparently did not dare to undertake any such investiga-
tion, even when a favorable opportunity for so doing pre-
sented itself, as it did on the occasion to which he refers
in the following brief extract taken from one of his
treatises : —

A carelessly constructed sepulchre on the banks of a river had
been undermined during a season of flood, and the corpse thus set
free had floated down stream a short distance, until it finally
lodged on the shore of a small cove. Passing near by I had the
opportunity of inspecting this corpse. The fleshy parts had already
disappeared to a great extent through the process of decomposition,
but the bones were still held together by their fibrous connections.
The picture presented to the eye was that of a human skeleton
specially prepared for the instruction of young physicians. On
another occasion, a few steps from the main road, I came across
the dead body of a robber who had been killed by the traveler
whose money he had attempted to steal. The peasants of that
neighborhood were not willing to bury the corpse of such a bad
man, and they accordingly allowed it to remain at the spot where
it was first discovered. In the course of the following two days,
as might be expected, the vultures removed every particle of flesh
from the bones, so that, when I saw what remained of the body,
the only thing visible was a nicely cleaned skeleton.

(Le Clerc: Histoire de la Medecine, p. 711.)

Here were two excellent opportunities for gaining the
additional knowledge of human anatomy which Galen so
much desired, but he evidently was not at all disposed to
avail himself of them — doubtless because his mind was
deeply imbued with the feeling that any such interference
on his part would be a sacrilegious act. Under the circum-
stances, therefore, there was nothing left for him to do but
to utilize animals for purposes of dissection, and more
particularly apes, whose anatomy very closely resembles

170 GROWTH OF MEDICINE

that of the human being. Several of Galen's books on
anatomy have come down to our time, but quite a number
of others have been lost. From those which we possess,
and especially from the one entitled ''Anatomical Admin-
istrations," it is permissible to conclude that he was a
most skilful dissector and an extremely close and careful
observer, and that he was very particular to set down
the results of his observations in admirably clear language.
Indeed, Le Clerc assures us that Vesalius, the great Flemish
anatomist of the sixteenth century, bestowed high praise
upon Galen's anatomical descriptions; and that, too, not-
withstanding the fact that the latter sometimes erred in
his statements regarding the similarity between certain
parts observed in dissections of an animal and the corre-
sponding parts in man. In one of his treatises- Galen
states distinctly that the arteries contain blood. In another
he gives a remarkably full and accurate description of the
nervous system, including the brain, spinal cord, and many
of the nerves.

He describes the optic nerve, the oculo-motorius and trochlearis,
the different ramifications of the trigeminus, the acusticus and
facialis, the vagus and glossopharyngeus, the nerves of the pharynx
and larynx, the sympatheticus (with the accompanying ganglia),
and the radial, ulnar, median, crural and ischiatic nerves. (Pusch-
mann. )

Although it is true that certain important anatomical and
physiological facts are found recorded for the first time
in the works of Galen, this must not be accepted as evidence
that Galen himself is the real discoverer of these facts.
The most that can be claimed for him is that he is the first
writer to bring the facts in question to the knowledge of
us moderns. When the ancient books that have been lost
are once more brought to light, as they very well may be
at any time, we shall be able, perhaps, to give credit where
credit is due. But there is one department in which Galen
did experimental work of an entirely original character and
for which he deserves unstinted praise. I refer to the
experiments which he made concerning the physiology of

2 Book VI., Chapter XVII. (page 441 of Vol. I. of Daremberg's version).

CLAUDIUS GALEN 171

the brain and spinal cord. They are related in the
following extract, which has been translated from the
account given by Neuburger {op. cit., Vol. I., p. 380) : —

The brain itself is not sensitive; it expands and contracts
synchronously with the respiratory movements, the purpose of
which action is to drive the pneuma from the cavities of that organ
into the nerves. The function of the meninges is to hold the parts
firmly together and to unite the blood-vessels. Pressure upon the
brain causes stupor. An injury of the tissues surrounding the
fourth ventricle or of those which constitute the beginning of the
spinal cord produces death. The seat of the soul is in the sub-
stance of the brain, and not in its membranes. The spinal cord
serves as a conductor of sensation and of motor impulses, and it
also plays the part of a brain for those structures of the body
which lie below the head. It gives off nerves like streamlets.
Division of the spinal cord longitudinally in its median axis does
not give rise to paralysis. Transverse division, on the other hand,
causes symmetrical paralyses. If the cord is divided between the
third and fourth cervical vertebrae, respiration is arrested, and
if the division is made between the cervical and the thoracic por-
tions of the spinal column, the animal breathes with the aid only
of its diaphragm and of the upper muscles of the trunk of the
body. Division of the recurrent nerves produces aphonia; if the
fifth cervical nerve is divided, the scapular muscles on the corre-
sponding side will be paralyzed. Galen considers the ganglia to
be organs for reinforcing the energy of the nerves. The fact that
both cerebral and spinal-cord nerve-filaments enter into the com-
position of the sympathetic nerve explains the extraordinary
sensitiveness of the abdominal organs.

When we consider that these experiments are the first
of their kind of which history makes mention, that they
were carried out nearly seventeen hundred years ago, and
that — so far as we know — they sprang entirely from the
brain of the experimenter, we may well express unlimited
admiration for Claudius Galen.

Daniel Le Clerc says that Galen's principal treatise on
human physiology, entitled ''Utility of the Different Parts
of the Human Body," constitutes a chef-d'oeuvre which
has challenged the admiration of physicians and phi-
losophers in all ages. Christians, however, he adds, are

/V

172 GROWTH OF MEDICINE

particularly gratified to learn from this work that ' ' Galen,
although classed as a Pagan, unhesitatingly recognizes that
it was an all-wise, an all-powerful, an all-good God who
created man and all the other animals." Further on,
Le Clerc refers to another statement which was made by
Galen and which will be found on page 261 of Daremberg's
version. It reads as follows: —

If I were to spend any more time in talking about such brutes —
by which term he designates men who cannot appreciate the wisdom
of God in distributing the different parts of the body in the manner
in which He has done this — I should justly incur the blame of
sensible persons. They would accuse me of desecratiag the account
which I am writing, an account which is intended as a hymn of
sincere praise of the Creator of man. I believe that true piety
consists, not in sacrificing numberless hecatombs nor in burning
unlimited quantities of incense and a thousand perfumes, but in
first searching out and then making known to my fellow men how
great are the wisdom, the power, and the goodness of the Creator.

Galen's work on ''The Utility of the Different Parts of
the Human Body" is composed of seventeen books, all of
which exist to-day in a complete state. Taken together
they form, as may be seen by the following list of contents,
a remarkably complete treatise on physiology. Books I.
and II. are devoted to the hand, forearm and arm (105
pages) ; Book III. to the thigh, leg and foot (62 pages) ;
Books IV. and V. to the alimentary organs and their
accessories (101 pages) ; Book VI. to the respiratory organs
(78 pages) ; Book VII. to the organs of the voice (67 pages) ;
Book VIII. to the head, the encephalon and the organs of
special sense (45 pages) ; Book IX. to the cranium, the
encephalon and the cranial nerves (38 pages) ; Book X. to
the eyes and their accessories (45 pages) ; Book XL to the
face and more particularly the jaws (55 pages) ; Book
XII. to the neck and the rest of the spinal column (46
pages) ; Book XIII. to the shoulder and the structure of
the spinal column in detail (40 pages) ; Books XIV. and XV.
to the genital organs and the parts in which the foetus
develops (70 pages) ; Book XVI. to the nerves, arteries
and veins (43 pages) ; and Book XVII. Epilogue (11 pages).

CLAUDIUS GALEN 173

There are very few modern text books in which the
author treats the subject in as exhaustive a manner as
Galen has done in these seventeen books. As may readily
be imagined from the great number and length of his
writings, he often wanders off into side issues and thus
lays himself open to the charge of being a diffuse writer.
At the same time he cannot be accused of dullness, for in
reading Daremberg's version one is seldom tempted to
omit any of the text, and his style is interesting. The
following brief extracts, to which should be added that
given on a previous page, may be taken as fair samples of
his manner of treating questions in the department of
physiology : —

Reasons why the Alae Nasi are Cartilaginous and why they may
he Moved by Voluntary Muscular Action. — ^We have already
explained in some measure the reasons why the alae nasi should
be composed of cartilage and why it should be possible for the
animal to move them at will.^ It is an established fact that the
movements of these parts are competent to aid in no small degree
the somewhat forcible inspirations and expirations. This is the
reason why the alae are constructed in such a manner as to be
easily movable. They are made of cartilage because this substance
is hard to fracture or to tear apart. The placing of these alar
movements under the control of the will, and not under that of
some other bodily force (like the arterial impulse, for example),
is certainly an excellent arrangement; and, if one does not appre-
ciate this without any further explanation, it must be because my
previous reasonings about such matters have fallen upon inatten-
tive ears.

(Translated from Book XI., Chapter XVII., of Daremberg's
French version of Galen's works.)

Another brief extract may be given here. It forms a
part of the chapter relating to the action of the sigmoid
valves of the pulmonary artery, etc., and merits special
attention because it furnishes additional evidence of the

8 In his Commentaries on the works of Hippocrates (Epidemic Diseases,
III., t. XVII. B. $ 4) Galen states that he has often observed this to-and-
fro movement of the alae nasi in certain cases of illness and that he has
interpreted it as indicating the existence of some serious disorder of the
respiratory tract. (Daremberg.)

/J

174 GROWTH OF MEDICINE

correctness of Daremberg's statement that Galen was the
leader of the most advanced school of experimentation: —

The more strongly the thorax, in its exertion of a compressing
force, tends to drive the blood (out of the heart), the more tightly
do these membranes (the sigmoid valves) close the opening.
Invested in a circular manner from within outward, extending
throughout the entire circumference of the interior of the vessel,
these membranous valves are, each one of them, so accurately
patterned and so perfectly fitted that when they are put upon the
stretch by the column of blood, they constitute a single large
membrane which closes (watertight) the orifice. Pushed back by
the return flow of the blood, they fall back against the inner sur-
face of the vein, and permit an easy passage of the blood through
the amply dilated orifice (which they, an instant before, closed so
perfectly).

(Translated from Book VI., Chapter XI., of Daremberg's French
version of the works of Galen.)

In his comments upon the account of the sigmoid valves
which I have just quoted, Daremberg says that the descrip-
tion of these structures given by Erasistratus at least four
hundred years earlier is admitted by Galen to be so correct
that it would scarcely be possible to furnish a better one.

Galen's Remarks upon, the Subject of Diagnosis. — In the
treatise entitled ''On the parts of the Body Affected"
(Book IL, Chapter X.) Galen gives the following advice
with regard to the method which it is desirable to adopt
when one wishes to ascertain which part or organ is
affected, what is the nature of the disease there located,
and whether it is primary in its nature or secondary to
some affection of earlier development: —

It should have been the special duty of Archigenes, who appeared
on the scene next in order after a series of the most illustrious
physicians,* to infuse more light into medical teaching. Unfortu-

4 Hippocrates, Herophilus, Erasistratus, Asclepiades, Themison, Celsus, Sora-
nus and Athenaeus. Daremberg calls attention to the fact that, although we
possess to-day only a few fragments of the writings of Archigenes, those few
are of such a degree of excellence that we may well ask ourselves whether
Galen was not perfectly justified in placing such a high estimate as he ap-
pears to have done upon the merits of this writer, — and that, too, notwith-

CLAUDIUS GALEN 175

nately, he did the very opposite ; for we who have grown old in the
exercise of the art (and should therefore find it easy to comprehend
what is written about medicine), are at times unable to understand
what he says. Such being the true state of affairs, I now propose
to undertake what Archigenes failed to accomplish. I shall com-
mence by indicating in a general way what is the proper method
to adopt when one wishes to ascertain in what part or organ the
disease is located and how one should proceed when it is proposed
to teach the method to others. This method may be stated in the
following terms : —

In the first place, the part should be carefully examined in order
that we may ascertain whether it presents any signs of special
value as indicating the nature of the disease. In the next place,
it is important in such an examination to know beforehand what
are the particular signs which belong to each of the diseases that
may affect the part or organ in question, and also whether these
signs vary according to the particular section of the organ involved.
In inflammation of the lung, for example, there are: difficulty in
breathing (dyspnoea) and great general distress (malaise), the
patient being obliged to remain in a sitting posture (orthopnoea) —
all of which are signs indicating the possibility of suffocation.
Furthermore, the air expired from the infected lung is sensibly
hot, especially if the inflammation is of the erysipelatous variety,
and, as a consequence, the patient shows a disposition to draw long
breaths, knowing that the cold air which he thus draws into his
lungs will afford him some measure of relief. The sputa expecto-
rated when he coughs are differently colored; some being red,
yellowish, or of a rusty appearance, while others are almost black,
livid, or frothy. The patient also often experiences the sensation
of a heavy weight in his chest, together with more or less pain,
which seems to be located deep down in that region and which
shoots backward into his spinal column or forward toward the
sternum. Add to these manifestations a high fever and a pulse
such as we have already described on another page, and you will
have

(Translated from Daremberg's French version of Galen's works.)

It has been said that Galen possessed more than the
ordinary share of vanity with regard to his cleverness as

standing the unfavorable criticism which he makes in the present paragraph
about the author's failure at times to write with sufficient clearness on med-
ical subjects.

176 GROWTH OF MEDICINE

a diagnostician; and certainly some of the accounts which
he gives, in his clinical and scientific treatises, of his own
experiences, seem to bear out this accusation. One hesi-
tates to expose the weak spots in the character of one of
the really great men of antiquity lest such exposure may
convey a wrong impression; at the same time it would be
an error to represent him as a man entirely free from the
foibles common to humanity, — even to the best and wisest
of men. I therefore repeat here Galen's own account of
a professional visit which he made to a brother physician
whose malady presented to himself and to his friends many
obscure features.

Upon the occasion of my first visit to Rome I completely won the
admiration of the philosopher Glaucon by the diagnosis which I
made in the case of one of his friends. Meeting me one day in the
street he shook hands with me and said : "I have just come from
the house of a sick man, and I wish that you would visit him with
me. He is a Sicilian physician, the same person with whom I was
walking when you met me the other day." "What is the matter
with him?" I asked. Then coming nearer to me he said, in the
frankest manner possible : ' ' Gorgias and Apelas told me yesterday
that you had made some diagnoses and prognoses which looked to
them more like acts of divination than products of the medical art
pure and simple. I would therefore like very much to see some
proof, not of your knowledge but of this extraordinary art which
you are said to possess." At this very moment we reached the
entrance of the patient's house, and so, to my regret, I was pre-
vented from having any further conversation with him on the
subject and from explaining to him how the element of good luck
often renders it possible for a physician to give, as it were off-
hand, diagnoses and prognoses of this exceptional character. Just
as we were approaching the first door, after entering the house,
we met a servant who had in his hand a basin which he had
brought from the sick room and which he was on his way to empty
upon the dung heap. As we passed him I appeared not to pay
any attention to the contents of the basin, but at a mere glance I
perceived that they consisted of a thin sanio-sanguinolent fluid,
in which floated excrementitious masses that resembled shreds of
flesh — an unmistakable evidence of disease of the liver. Glaucon
and I, not a word having been spoken by either of us, passed on
into the patient's room. When I put out my hand to feel of the

CLAUDIUS GALEN 177

latter 's pulse, he called my attention to the fact that he had just
had a stool, and that, owing to the circumstance of his having
gotten out of bed, his pulse might be accelerated. It was in fact
somewhat more rapid than it should be, but I attributed this to
the existence of an inflammation. Then, observing upon the window
sill a vessel containing a mixture of hyssop and honey and water,
I made up my mind that the patient, who was himself a physician,
believed that the malady from which he was suffering was a
pleurisy; the pain which he experienced on the right side in the
region of the false ribs (and which is also associated with inflam-
mation of the liver) confirming him in this belief, and thus induc-
ing him to order for the relief of the slight accompanying cough
the mixture to which I have just called attention. It was then
that the idea came into my mind that, as fortune had thrown the
opportunity in my way, I would avail myself of it to enhance my
reputation in Glaucon 's estimation. Accordingly, placing my hand
on the patient 's right side over the false rib, I remarked : ' * This
is the spot where the disease is located." He, supposing that I
must have gained this knowledge by simply feeling his pulse,
replied with a look which plainly expressed admiration mingled
with astonishment, that I was entirely right. "And" — I added
simply to increase his astonishment — "you will doubtless admit
that at long intervals you feel impelled to indulge in a shallow,
dry cough, unaccompanied by any expectoration. ' ' As luck would
have it, he coughed in just this manner almost before I had got
the words out of my mouth. At this Glaucon, who had hitherto
not spoken a word, broke out into a volley of praises. "Do not
imagine," I replied, "that what you have observed represents
the utmost of which medical art is capable in the matter of fathom-
ing the mysteries of disease in a living person. There still remain
one or two other symptoms to which I will direct your attention. ' '
Turning then to the patient I remarked: "When you draw a
longer breath you feel a more marked pain, do you not, in the
region which I indicated; and with this pain there is associated
a sense of weight in the hypochondrium ? " At these words the
patient expressed his astonishment and admiration in the strongest
possible terms. I wanted to go a step farther and announce to
my audience still another symptom which is sometimes observed
in the more serious maladies of the liver (scirrhus, for example),
but I was afraid that I might compromise the laudation which
had been bestowed upon me. It then occurred to me that I might
safely make the announcement if I put it somewhat in the form

178 '■ GROWTH OF MEDICINE

of a prognosis. So I remarked to the patient: "You will prob-
ably soon experience, if you have not already done so, a sensation
of something pulling upon the right clavicle." He admitted that
he had already noticed this symptom. "Then I will give just
one more evidence of this power of divination which you believe
that I possess. You, yourself, before I arrived on the scene, had
made up your mind that your ailment was an attack of pleurisy,
etc."

Glaucon's confidence in me and in the medical art, after this
episode, was unbounded.

Thirty or forty years elapsed after Galen's death before
the Profession began to realize how great an authority he
had become in all matters relating to medicine ; not perhaps
among the majority of physicians, but among the better
educated and those more given to reasoning about the
various problems in physiology and pathology. Then came
the invasion of Eome by the Barbarians, and with it the
scattering of nearly all those who were at the time prac-
ticing medicine in that great city. This was the beginning
of the long period known as the Middle Ages, a period
during which, so far as Italy and Gaul were concerned, the
science of medicine made no advance whatever. The
physicians living in a precarious manner in the to^vns, and
the monks who practiced medicine in the country districts,
took very little interest, as may readily be imagined, in the
achievements of Galen. Through all those years they
clung to the doctrines of the Methodists, as revealed to
them in the work of Caelius Aurelianus, the favorite
medical treatise of that period. It was only during the
latter part of the Middle Ages that Galen's teachings
began once more to be appreciated at their true value;
and, as time went on, they gained a stronger and stronger
hold on the minds of medical men, until finally they held
undisputed sway. Friedlaender, speaking of medicine in
those dark times, uses these words: *' Galen's colossal
personality loomed up throughout that long night as a
brilliant guiding star to light the intricate pathways of
medicine. ' '

CHAPTER XVI

THE INFLUENCE OF CHRISTIANITY UPON THE
EVOLUTION OF MEDICINE

The religion established by Jesus Christ in Judea during
the early part of the first century remained confined within
the limits of that region for a number of years, but already
during the latter half of that period groups of Christians
were to be found in every part of the Roman Empire, and
in certain localities the membership of the new church had
increased so greatly in numbers as to excite the alarm and
hostility of the temple priests and of the governing officials.
Persecutions, especially in the city of Rome and at the
instigation of Nero, became more and more frequent and
more and more pitiless, but they failed utterly to destroy
the new religion, so firmly was it rooted in the followers
of Jesus Christ. As a matter of fact its spread was
checked for only a few years, and then its adherents
increased in numbers more rapidly than ever. Neuburger,
in his '* History of Medicine," makes the following quota-
tion from the account which Dionysius of Alexandria gives
of the great plague that occurred during the third century
A. D.:

The majority of our brethren in their love for their neighbors
did not spare themselves, but acted as a unit in their efforts to
assist. They visited the sick without the slightest fear and gave

them the very best of care, for the sake of Christ Among

the non- Christians, however, the very opposite was true. As soon
as any of their number fell ill they pushed them to one side, even
those who were dearest to them, and, before they were more than
half-dead, they threw them out into the street and took no care to
bury the dead bodies.

180 GROWTH OF MEDICINE

Such an example of self-sacrifice and humanity — and
there must have been very many similar examples — could
not possibly have failed to make a profound impression
upon the community at large. Daniel Le Clerc says that
three physicians suffered martyrdom for their Christian
faith during the reigns of the Emperors Marcus Aurelius,
Lucius Verus and Commodus. They were Papila (of
Pergamum), Alexander (of Lyons) and Sanctus (a con-
temporary of Galen), whose death was of a particularly
cruel character. Credit should also be given to Chris-
tianity, says the same writer, for having established the
rule that every community should assume the expense and
responsibility of caring for its own poor and sick. This
was a step of the greatest importance ; and, at a still later
period, when Christianity became largely an affair of the
state, a complete hospital organization was effected, with
the bishop as the chief officer and, under him, deacons and
deaconesses. Such well-organized institutions proved to
be of the greatest possible benefit to the advance of medical
science. They were the worthy successors of those more
ancient hospitals, the Aesculapian temples, which were first
established by the Greeks in the pre-Hippocratic age, and
they have continued in an unbroken chain from the institu-
tions of those primitive times to the thoroughly well-
equipped hospitals of the present day.

In 330 A. D. the new capital of the Eoman Empire was
established in Byzantium, afterward called Constanti-
nople, and Eome, which for hundreds of years had been
the metropolis of the world and the source from which a
large part of Roman history had emanated, was given a
subordinate position. Then followed, in 410 A. D., the
conquest of the latter city by the Visigoths, a horde of
uneducated Barbarians who had felt the might of Rome
in previous years, and who now doubtless took immense
satisfaction in humiliating her and in destroying her
valuable possessions. There are good reasons for believing
that, when the Emperor Constantine established his resi-
dence in Byzantium, the leading physicians of Rome
followed him ; and it is not likely that many of those who,

TEE INFLUENCE OF CHRISTIANITY 181

for one reason or another, preferred to remain in the old
capital, continued to do so after it became known that the
Barbarians were approaching the city. But the migration
of these physicians to the new capital did not mean a
renewal there of the scientific activity which had charac-
terized the growth of Greek medicine in Rome during the
first two centuries of the Christian Era. It is probable that
the fugitives, being obliged to travel with the smallest
amount of baggage possible, left the major part of their
books and papyrus rolls behind, hoping, no doubt, that they
might be able at some later date to recover them. But the
favorable occasion never arrived, and thus a great deal
of valuable medical literature entirely disappeared. The
loss, however, might have been even more serious than it
was if the Christian church had not already (during the
third century) begun to establish monasteries in secluded
and inaccessible spots. It was to these institutions that
not only books of a religious character, but also those
relating to the science of medicine, were transported for
safe keeping during the early Middle Ages. Farther on,
I shall have occasion to refer to this subject again and to
discuss more fully certain other benefits which accrued
to medical science from these monastic institutions.

But while, on the one hand, the Christian church through
the instrumentality of the monasteries was lending its aid
to the preservation of the sources of medical knowledge,
it was, on the other, doing its best to arrest all further
evolution of that branch of science; not consciously, it
must be admitted, but through a mistaken sense of its duty
to God. Thus it came about that the Emperor Justinian I.
(527-567 A. D.), acting under the narrow-minded advice of
his ecclesiastical counsellors, closed the medical schools at
Athens and Alexandria and at the same time withdrew the
regular allowance of money which up to that time had been
paid to the state physicians and to special scholars. A
few years later, however {i.e., in the early part of the
seventh century A. D.), some of the more highly educated
physicians of Alexandria got together and made the
attempt to organize a school of medicine in that city. A

182 GROWTH OF MEDICINE

course of lectures was planned and sixteen of Galen's
works, carefully chosen for the purpose, were made the
basis of the new course of instruction. The books selected
were first carefully edited and simplified, and then commen-
taries were added in order that in their final >shape these
treatises might be better suited to the uses of students.
The invasion of Alexandria by the Arabs, however, soon
put an effectual stop to this promising attempt to revive
Greek medicine.

In this brief sketch I have thus far mentioned only the
more direct effects produced by the new religion upon the
evolution of medicine. The indirect effects, however, were
also in some cases of very great importance. At the
beginning of her history there developed in the Christian
church, among her chief men, a strong disposition to
quarrel over dogmas. To apply the term quarrelsomeness
to this tendency may easily convey a wrong impression.
It was, more strictly speaking, a highly developed con-
scientiousness on the part of men whose minds were deeply
imbued with the idea that they were rendering God a service
by keeping what they believed to be the true and only
religion free from errors of all kinds. It took many
centuries to impress the leaders of the church with the
fact that the religion of Jesus Christ, like the science of
medicine or the natural sciences, was capable of develop-
ment to an almost indefinite extent ; and it is owing to our
appreciation of this important fact that we moderns look
with so much more lenient eyes upon the distressing, not
to say cruel, events of mediaeval ecclesiastical history.
At the time of which I am now writing, however, it was
considered highly unchristian — especially for one holding
authority in the church — to believe otherwise than as her
doctrines taught; and accordingly, in the early part of the
fifth century A. D., Nestorius, the Patriarch of Constanti-
nople, was deposed from his high office by a Council of the
church and imprisoned because he was unwilling to teach
the doctrine of the miraculous birth of Jesus Christ.
Those who accepted the view held by Nestorius — and they
eventually became a very numerous and a very influential

THE INFLUENCE OF CHRISTIANITY 183

body of Christians — ^were driven out of Constantinople and
compelled to seek homes in distant places. This affords,
perhaps, an explanation of the fact that, during the eighth
century A. D., many Nestorian Christians were found living
in the eastern part of Syria and in Persia; and it seems
fair to assume that these Christian communities repre-
sented to some extent the direct successors of those Nesto-
rians who had taken refuge in this remote corner of Asia
Minor three hundred years earlier. Furthermore, it is
highly probable that there were Christian communities in
this region several centuries before the Nestorians arrived,
for it is believed that the Apostles James and Thomas
visited Persia and the northeastern part of Syria in the
course of their work as evangelists. It is not known,
though, how many of the descendants of these earlier
Christians adopted the peculiar beliefs of the Nestorian
refugees.

And here it should be stated that the facts which have
thus far been mentioned are not the only ones that throw
some light upon the relationship subsisting between Chris-
tianity and the spread of medical knowledge to Western
Europe. Those which remain to be considered are of two
kinds, viz., facts relating to the origin of the Arabic
Renaissance, and facts which show that the Christian
church, from the fourth century onward, was contributing
not a little, through the establishment of the great monastic
orders, such as the Benedictines, the Dominicans, and the
Franciscans, to the preservation if not to the further
evolution of Graeco-Roman medical knowledge. I shall
reserve for consideration in a later chapter this particular
part of the history of medicine; and in the meantime I
shall endeavor to describe the events which preceded and
rendered possible the active study of Greek medicine on
the part of the followers of Mohammed.

So far as history furnishes us with any information on
the subject, the Nestorians who lived in Persia, Syria and
Mesopotamia were Christians of a remarkably liberal type.
They appear to have been an unusually peaceable people,
for not only were they kindly disposed toward one another,

184 GROWTH OF MEDICINE

but they seem to have been on the best of terms with their
Jewish neighbors, who, like themselves, were eager after
knowledge. Already at a very early period there existed
at Djondisabour — a town which had been founded in the
Province of Khorassan, in the northeastern part of Persia,
about the year 260 A. D., by Sapor II., King of that
country — a school in which the medicine of Hippocrates
was taught. Freind, in his ''History of Physick" (London,
1727), says that about the year 272 A. D. the Emperor
Aurelian (Lucius Domitius Aurelianus), as a compliment
to his daughter, who was the wife of the King of Persia,
sent to Djondisabour, the city in which she resided, several
Greek physicians; and Abulpharagius, the Arab historian
(thirteenth century), intimates that these were the men who
conducted the teaching in the newly established medical
school. Another possibility suggests itself. After the
death of Alexander the Great in Babylon (323 B. C), from
malarial fever, it is not unlikely that some of the numerous
Greek physicians who accompanied the army in an official
character, and who, we are warranted in believing, were
exceptionally well educated, decided not to remain in that
unhealthy district, but to settle in some of the neighboring
towns {e.g., Nisibis in the hill country to the north of
Babylon, or Sura to the east of the river Tigris) ; and that
these men also contributed their share toward the planting
and perpetuation of Greek medicine in this district of the
Orient. However, the salient fact in this period of the
history of medicine is this: When Almansur, the Caliph
of Bagdad (712 to 775 A. D.), made up his mind to introduce
Greek medicine into his kingdom and looked around for
the ways and means of accomplishing this, he found at the
city of Djondisabour men who were not only well versed
in Greek medicine, but who at the same time were so thor-
oughly grounded in all departments of scholarship that
they could at once begin the work of translating the writings
of Hippocrates and other classical medical authors into
Arabic, the language of the Mohammedans. But at this
stage of affairs the existence of a serious obstacle was
discovered. The writings which it was proposed to trans-

THE INFLUENCE OF CHRISTIANITY 185

late were not immediately obtainable, and it therefore
became necessary to institute without delay a vigorous
search for the books required. In order that the reader
may appreciate fully the difficulties which Almansur had
to overcome, in this matter of a scarcity of Greek originals,
it seems best to pause at this point, and to review briefly
some of the facts which bear upon the question at issue.

The Wholesale Destruction of Medical Literature during
the Early Centuries of the Christian Era. — The invasion
of Eome in 410 A. D. was one of the first events which
entailed a serious loss of the Greek medical books that had
been accumulating for several centuries in that city. Fortu-
nately, not a few of these works were rescued in time by
the church authorities and deposited for safe keeping in
the various monasteries scattered all over the Roman
Empire. A still more serious destruction of books occurred
about the year 638 A. D., when Amrou, a famous Arabian
warrior, captured Alexandria and — under the instructions
of his master, Omar ben Khattab — destroyed the greater
part of the contents of the famous libraries located in that
city. The narrative of this event, as told by Lucien
Le Clerc, is as follows: —

John the Grammarian,^ who was living at that time in Alex-
andria, held the following conversation with Amrou on a certain
occasion : * ' You have inspected all the edifices of Alexandria, and
have sequestrated all their contents. I have no objections to your
appropriating everything that may be of use to you; there are
certain things, however, which you may not wish to possess, but
which are highly prized by us. ' '

"What are those objects?" inquired Amrou.

1 John the Grammarian, whose nativity is not stated by Le Clerc, was at
first a simple boatman who ferried back and forth those who attended a school
which was located on one of the islands at Alexandria. As a result of his
frequent talks with these men, he became enamored with philosophy and
decided, notwithstanding his age (forty years), to devote himself entirely
to the study of the subject. Accordingly, he sold his boat and attended the
lectures regularly, becoming at last an expert in philosophy. He wrote several
important treatises and commentaries, some of them dealing with medical
topics, and he also made a number of translations from the Greek into Arabic.

186 GROWTH OF MEDICINE

''The works on philosophy, which are contained in the public
libraries," John replied.

"I can do nothing about them without a special order from the
Prince of Believers, Omar ben Khattab," was the answer given
by Amrou.

John's wish having in the meantime been conveyed by the
General to Omar, the latter sent this reply : —

"As to the books of which you speak, I have this to say. If their
contents agree with what is written in the word of God, the books
are of no use to us, the Holy Writ being sufficient for our guidance.
But if they are at variance with God's word, then surely they
should be destroyed."

Amrou therefore ordered all the books to be sent to the bathing
establishments of Alexandria, to be used as fuel in heating the
baths. So great was the number of books contained in the libraries
that it took six months to consume them all. (Sismondi questions
the correctness of this account.)

While the invasion of Rome by the Barbarians in the
fifth century and the capture of Alexandria by the Arabs
in the early part of the seventh gave rise to an enormous
loss of valuable books relating to medicine and philosophy
in general, these were by no means the only occasions when
books were probably destroyed in great quantities. Wars
were frequent in those days and towns were constantly
being sacked. Everywhere throughout the East the modern
traveler encounters the ruins of large cities, and in those
cities — the centres, as they were, of wealth and culture —
there must have been large collections of books. It is not
at all strange, therefore, that when the Caliph Almansur
made a serious beginning of the work which was to convert
the Arabs into rivals of the ancient Greeks, he should have
found a great scarcity of medical works which, after being
translated, were to serve as manuals of instruction. How-
ever, his ambition was very great, his wealth almost
inexhaustible, and his associates eager to aid him in
realizing the renaissance which he had planned for his
people ; and, as will appear later on, he and those who aided
him eventually succeeded in overcoming this apparently
insurmountable obstacle.

TEE INFLUENCE OF CHRISTIANITY 187

Among the medical books which, upon the approach of
the Goths, were carried from Eome and other cities to
different monasteries for safe keeping there must have
been very few that were written in Latin, and yet these
were the only ones from which the monks individually
could derive any benefit. Several centuries later, when all
the monasteries of Italy and the East were visited by those
who were searching eagerly for original manuscript-copies
of the Greek medical writers, — Hippocrates, Soranus,
Eufus of Ephesus, Aretaeus, Dioscorides, Galen, — it was
found that such copies existed in a number of these insti-
tutions, thus showing that the monks had been actuated
by unselfish and far-seeing loyalty to the best interests of
mankind when they rescued these particular treasures
from the hands of the enemy. They themselves could make
no use of them, being unable to read Greek, but they knew
their priceless value to medical science.

The Latin treatises which they had also rescued, and of
which they made excellent use during the succeeding cen-
turies, were those of Celsus, Scribonius Largus, Pliny the
Elder (to a slight degree only) and Caelius Aurelianus.

%\

/r1

PART II
MEDIAEVAL MEDICINE

I'll

CHAPTER XVII

THE CONDITION OF MEDICINE AT BYZANTIUM
DURING THE EARLY PART OF THE MIDDLE
AGES

The Byzantine period of the history of medicine begins
about the middle of the fourth century A. D. and retains
some degree of importance up to or perhaps a little beyond
the beginning of the eighth century. During this period
of nearly four centuries there appeared on the scene
five physicians whose writings form a very creditable
part of the late Greek medical literature. The names of
these authors are : Oribasius, Aetius, Alexander of Tralles,
Theodore Priscianus and Paulus Aegineta.

Oribasius. — The first physician . named in this list,
Oribasius, was born about the year 325 A. D. in Pergamum,
an important city of Asia Minor and the birthplace of
Galen. He received his medical training at Alexandria,
settled in Constantinople (the new name given to Byzan-
tium), and soon afterward became the personal physician
of the Emperor Julian the Apostate, the nephew of
Constantine the Great. Subsequently he was appointed
Quaestor of Constantinople, but, upon the death of Julian
(363 A. D.) and the accession of Valens and Valentinianus
to power, his property was confiscated and he himself was
obliged to take refuge among the Ostrogoths, who dwelt
on the shores of the Black Sea. These people received
him with open arms, and he soon acquired great influence
among them. After a time, however, he was recalled to
Constantinople and all his former privileges were once
more granted to him. He died about the year 403 A. D.

192 GROWTH OF MEDICINE

Despite his duties as a practicing physician of the very
highest rank — duties which he could not wholly set aside
when he accepted the office of Quaestor of Constantinople —
and despite the necessity of devoting considerable time to
the work which this non-medical official position entailed,
Oribasius, like Pliny, appears to have been a most energetic
contributor to medical literature. We possess to-day, for
example, a large part of the medical cyclopaedia (72
books) which he prepared at the command of the Emperor
Julian, and which — even in its incomplete state — contains
very full information regarding anatomy, physiology,
surgery, pathology and pharmacology. Although the work
is simply a compilation, its present value is great, for it
contains numerous extracts from earlier and contemporary
treatises, many of which have entirely disappeared, —
treatises of which we should have had no knowledge what-
ever if Oribasius had not introduced numerous extracts
from them into his cyclopaedia.

About the year 390 A. D., when Oribasius was already an
old man, he published (in nine books) a "Synopsis" of the
larger work, chiefly for the benefit of his son Eustathios,
who was at that time studying medicine. Surgery is
omitted from this work, as that branch of medicine was
assumed to belong entirely to specialists. At a still later
date (about 395 A. D.), Oribasius published a third work
(in four books) entitled "Euporista," which was intended
chiefly for the use of laymen. The subject-matter of this
treatise consists of diet, hygiene and general therapeutics.
Neuburger speaks well of all three of the published works
of Oribasius, and furnishes a fairly full analysis of the
contents of each one.

Bussemaker and Daremberg have published, in six
volumes (Paris, 1856-1876), an excellent French version
of the works of Oribasius.

Priscianus. — Theodorus Priscianus lived during the
latter part of the fourth and the first part of the fifth cen-
tury of the present era. Very little is known about his
professional career beyond the facts that he was a pupil
of Vindicianus, a distinguished physician who lived during

MEDICINE IN THE MIDDLE AGES 193

the reign of the Emperor Valentinianus I. at Constanti-
nople (364-375 A. D.), and that subsequently he was chosen
the private physician of the Emperor Gratianus (375-383
A. D.). The treatise which he composed, and which bore
the title of ' * Euporiston, ' ' was originally written in Greek,
but was afterward translated by its author into Latin. An
excellent German version of the work by Meyer-Steineg
was published in Jena in 1909. As the book was intended
by Priscianus to serve chiefly as a guide to practitioners
of the art, it contains practically nothing about anatomy
and physiology. In his pathology he follows closely the
teachings of the Methodists; his first question, in the
presence of a case of illness, being: **Do the symptoms
point to a condition of strictum rather than to one of laxum,
or vice versa? ^^ **In his treatment," says Meyer-Steineg,
'* Priscianus follows very closely the rule that every
patient, no matter what may be the disease with which he
is affected, should first undergo a certain amount of general
treatment." In his choice of remedies Priscianus inva-
riably gives the preference to those agents which are of
a simple character and easy to obtain. On the other hand,
he does not hesitate to admit that he sometimes employs
certain magical remedies, as is shown by the following
quotation taken from Book IV., Chapter I., section 4: —

If a person wears, during the waning of the moon, a wreath of
polygonum on his head, he will obtain relief from his headache.

If one drinks of the water from which an ox has just

drank, he will be relieved of the pain in his head If a

loadstone be held upon the head it will draw out the hidden pain,
and the same effect may be obtained by rubbing over the forehead
a swallow's nest thoroughly mixed with vinegar.

In Book I., paragraph 2, Priscianus draws a picture of
the rude and uncivilized behavior of the practitioners of
his day in the sick-room. The following are his words as
translated from the German of Meyer-Steineg : —

As the patient lies on his bed prostrated by the severity of the
disease, there quickly comes into the room a crowd of us physi-
cians. No feeling of sympathy for the sick man have we, nor do

194 GROWTH OF MEDICINE

we realize how impotent we all are in the presence of these forces
of nature. Instead, we struggle to the utmost of our ability to
obtain charge of the case ; one depending for success on his powers
of persuasion, a second on the strength of the arguments which
he is able to bring forward, a third on his readiness to agree with
everything that is said, and the fourth on his skill in contradicting
the opinion of everybody else. And, as this quarrel goes on, the
patient continues to lie there in a state of exhaustion. "For
shame!" Nature seems to say, "you men are an ungrateful lot!
You do not even permit the patient to die quietly ; you simply kill
him. And then, moreover, you accuse me of not furnishing suffi-
cient means of effecting a cure. Illness is certainly a painful
affair, but I have provided plenty of remedies. Poisons, I admit,
are hidden in some of the plants, but the healing agents which may
be extracted from them are much more numerous. Away, then,
with your angry disputes and your self-glorifying chatter; for
in these are not to be found the remedial agents which I have
bestowed upon man, but rather in the powerful forces which reside
in the seeds, fruits, plants and other objects which I have created
in his interests."

Aetius. — Aetius was a native of Amida, in Mesopotamia,
and he lived during the early part of the sixth century
A. D., under the Emperor Justinian I. He studied medicine
at Alexandria and then settled in Constantinople, where
he was appointed to the double office of private physician
to the emperor and commanding officer of his body-guard
{Comes obsequii), — an arrangement which made it prac-
ticable for the emperor to have his physician near his
person on all possible occasions. Almost nothing is known
about the subsequent private life and professional career
of Aetius beyond the facts that he was a Christian and that
he wrote a treatise on medicine in sixteen books, which
together form a large volume. The work, says Le Clerc,
is almost entirely a compilation from the treatises of
earlier writers on medicine and surgery; the best parts of
the book being those which relate to the pathology and
treatment of internal diseases, to materia medica, and to
ophthalmology. The Christianity of Aetius, like that of
Alexander of Tralles, and other physicians of a later
period, appears to have permitted a belief in magical

MEDICINE IN THE MIDDLE AGES 195

remedies. For example, Aetius gives formulae containing
the names of the Saviour and the Holy Martyrs for
exorcising certain maladies, and he recommends the
employment of amulets. The subject of baths is treated
by him quite thoroughly, and he lays stress upon the
importance of physical exercise as a means of maintaining
one's health. Freind, the author of an English history of
medicine which was very popular in its day,^ quotes the
following remedy for gout from the treatise of Aetius: —

In September to drink milk;
in October to eat garlick;
in November to abstain from bathing ;
in December not to eat cabbage ;

in January to take a glass of pure wine in the morning ;
in February to eat no beet ;

in March to mix sweet things both in eatables and drinkables ;
in April not to eat horseradish ;
nor in May the fish called Polypus ;

in June to drink cold water ; — and so on through the remainder of
the year.

At the end of the French version of ^^Les Oeuvres de
Rufus d' iSphese" (translated from the Greek by Darem-
berg and Ruelle) will be found fragments of some of the
books of Aetius; in 1899 J. Hirschberg translated into
German Book VII. (eye diseases) of the same author; and,
two years later (1901) Max Wegscheider published a
German version of Book XVI. (obstetrics and gynaecology).
No other translations of the writings of Aetius into either
French, German or English are — so far as I am able to
learn — available.

Alexander of Tralles. — Alexander of Tralles, a city of
Lydia, in Asia Minor, was bom about 525 A. D. His
father Stephanus was highly esteemed as a practicing
physician, and his four brothers, all of them older than
himself, were men of distinction in their several callings;
Anthemius, the oldest, being one of the greatest mathe-
maticians and mechanicians of his day and the man to

1 Third edition, London, 1726.

196 GROWTH OF MEDICINE

whom the Emperor Justinian intrusted the rebuilding of
the church of St. Sophia in Constantinople;^ Metrodorus,
a celebrated grammarian and the honored teacher of the
youth belonging to the highest circles of that metropolis;
Olympius, a leading authority in jurisprudence; and
Dioscorus, a prominent physician in his native city.
Alexander received his first instruction in medicine from
his father, but he obtained his real training from a physi-
cian who was the father of his most intimate friend Cosmas,
and who, throughout Alexander's entire subsequent career,
proved most helpful in advancing his interests. At first
he traveled extensively, visiting in succession — probably
in the capacity of a military surgeon — Italy, Northern
Africa, Gaul and Spain. Afterward, he settled perma-
nently at Rome and practiced medicine there during the
remainder of a long life. Puschmann, the translator of
his writings, seems disposed to believe that he was both
a teacher and a practitioner of medicine during his resi-
dence in that city. When he became too old to bear the
heavy burdens of medical practice, he wrote an account of
his life, — a life which was rich in professional experience, —
and thus built for himself **a monument more striking and
more durable than the splendid temple erected by his eldest
brother." (Meyer, quoted by Puschmann.)

Various circumstances justify the conclusion that Alex-
ander of Tralles was a Christian. His style of writing
is simple and direct, and he states his views with a degree
of modesty which wins for him at once the sympathy and
confidence of his readers. He gives full and generous
recognition to the great physicians who lived and wrote
before his time, and more especially to Hippocrates. On
the other hand, he does not hesitate, when he believes that
he is right, to put forward views which are in direct
antagonism with those of even so great an authority as
Galen. In the domain of therapeutics, says Puschmann,
Alexander was decidedly superior to Galen. His teachings

2 Anthemius is also credited with beiag the inventor of the principle of
dome construction in architecture.

MEDICINE IN THE MIDDLE AGES 197

are based on experience gained in actual practice, whereas
Galen was very often disposed to trust to considerations
of a theoretical nature; for he was chiefly interested in
establishing the pathology of the different diseases and in
opening up new territories in medicine in which the human
mind might display its activity.

The twelve books of which the treatise of Alexander of
Tralles consists, were printed in the original Greek for
the first time in 1548, by Eobert ^fitienne, the celebrated
printer of Francis L, King of France. The last and most
perfect edition of the Greek text is that of the late Dr.
Theodore Puschmann, which was published in Vienna in
1878 (two Vols.). It contains, in addition to the Greek
version, a careful analysis of the twelve individual books,
and an admirable German translation of the entire work.
It is from the latter that the following brief extracts
(translated into English) are taken: —

Introduction to the writings of Alexander of Tralles. — Upon
a certain occasion, my dearest Cosmas, thou didst urge me to
publish my rich experiences in the domain of practical medicine,
and I am now gladly complying with thy wish, for I feel under
deep obligations to both thyself and thy father for the kindness
which you have shown to me on every possible occasion in the past.
Thy father was always a most helpful patron to me, not only in
my practice, but also in all other relations of life. And thou also,
even when thou wert living abroad, stood staunchly by me through
all the trials which I experienced and the severe blows dealt me by
Fate. For these reasons I will now in my old age, when it is no
longer possible for me to endure the labor and worries of practice,
do as thou desirest, and will write a book in which shall be set
forth the experience which I have gained during my long service
in the treatment of disease. I hope that many of those who read
what is here written, with minds free from jealousy, will experience
real pleasure in noting the well-founded and scientific character
of the rules which I have laid down and the brevity and preciseness
of my descriptions. For I have done my very best always to
employ simple words, in order that everybody may find it easy
to understand my book.

Some Magical Remedies or Amulets Recommended hy Alex-
ander of Tralles, as Effective in the Treatment of Colic. — The

198 GROWTH OF MEDICINE

Thracians remove the heart from a lark while the bird is still alive,
and wear it, prepared as an amulet, on the left thigh.

Procure a little of the dung of a wolf, preferably some which
contains small bits of bone, and pack it in a tube which the patient
may easily wear as an amulet on his right arm, thigh, or hip during
the attack. He must be very careful, however, not to allow the
parts around the seat of the pain to come in contact with the earth
or with the water of a bath. This amulet is, in my experience, an
unfailing remedy, and almost all physicians of any celebrity have
commended its virtues.

Remove the nipple-like projection from the caecum of a young
pig, mix myrrh with it, wrap it in the skin of a wolf or dog, and
instruct the patient to wear it as an amulet during the waning of
the moon. Striking effects may be looked for from this remedy.

Let the design of Hercules throttling a lion be engraved upon
a Median stone, and then instruct the patient to wear it on his
finger after it has been properly set in a ring of gold.

Take an iron ring and have the hoop made eight-sided. Then
engrave upon the eighth side these words: "Flee, flee, oh Gaul!
the lark has sought thee out." On the under surface of the
head or seal of the ring engrave the letters J. C, thus:
I have often made use of this amulet; and, while I should
consider it wrong to keep silence about a remedial agent of
such extraordinary efficacy in cases of colic, I feel bound to say
that it should not be recommended to the first comer, but only to
believers and to those individuals who know how to guard it
carefully. The Great Hippocrates, with remarkable insight, gave
the advice that things which are holy should be intrusted only to
those who are of a religious character, and should be withheld from
the profane. As regards the ring, however, the patient must be
careful, before wearing it, to have a sketch made of it on either
the seventeenth or the twenty-first day of the moon.

Alexander has been severely criticised for his advocacy
of the employment of amulets in the treatment of diseases ;
but he defends himself against such criticism by saying that
physicians owe it as a duty to their patients to study care-
fully what he calls the hidden forces of nature, and to pay
unprejudiced attention to the effects produced by amulets
and other magical remedies. He reminds his critics that
Galen and other eminent medical authorities have insisted
that a place be given to this class of agents in the list of

MEDICINE IN THE MIDDLE AGES 199

authorized remedies; and lie adds that Galen further
emphasizes the duty of the physician to employ them when
other measures fail, or when the patients themselves
frankly confess that they have faith in their efficacy and
therefore wish them to be tried. Alexander also makes the
statement that Galen, after treating for a long time all
reports about the beneficial results obtained from the
employment of magical measures as old women 's tales, had
finally decided that these benefits were at times marvelous
and should be accepted as genuine by physicians even if
they are unable to explain them.

How much Alexander of Tralles really believed in these
supernatural agents, or to what extent he relied upon their
effect in influencing the imagination, we may not know;
but his was an age of superstition, and the conditions
governing society at that time were very different from
those which control the world at the present day.

Paulus Aegineta. — Paulus Aegineta^ was born in the
Island of Aegina, not far from Athens, in the early part of
the seventh century A. D., and practiced medicine in
Alexandria, Egypt. He is known to us as the author of a
compend of medicine which was very popular during a long
period of time, especially among the Arabs, who, as early
as two hundred years after his death, translated his work
from the Greek into their own language. At a still later
period it was also translated into Latin, the two best ver-
sions in this language which we now possess being those
of Guintherus Andernacus (Paris, 1532) and of J. Cor-
narius (Basel, 1556). There is also an English translation
by F. Adams (''The Seven Books of Paulus Aegineta,*'
London, 1845-1847), which is favorably spoken of by
Neuburger, and which is apparently at the present time
the only existing version of the work of Paulus of Aegina in
a modern European language; for the French translation
by Rene Brian (''La Chirurgie de Paul d'J^gine/' Paris,
1855) comprises only Book VI.

The contents of the entire work are as follows:
Book I. — Dietetics of Pregnant Women and of Children;

8 Also written Paulus Aeginetes.

200 GROWTH OF MEDICINE

Children's Diseases; Massage, Gymnastics, Sexual Hy-
giene, Bathing, etc.; Booh //.^General Pathology, the
Doctrine of Fevers, Semeiology; Booh III. — Diseases of
the Hair, Diseases of the Brain and Nerves, Diseases of the
Eyes, Ears, Nose, Mouth, Teeth and Face; Booh IV. —
Leprosy, Skin Diseases, ^fnflammations. Swellings, Tumors,
Wounds, Ulcers, Fistulae, Hemorrhage, Worms, Affections
of the Joints, etc.; Booh V. — Toxicology; Booh VI. — Sur-
gery; Booh VII. — Materia Medica.

To furnish even a very superficial analysis of the contents
of this treatise would call for more space than can well
be given up here to such a purpose. I shall therefore
simply mention a few points of special interest to which
Neuburger calls attention in the course of his very full
analysis of the work. He states, for example, that Paulus
mentions several instances in which patients affected with
lung disease, coughed up calculi or small stone-like masses.
He also states that the same author was familiar with the
fact that in the course of ''phthisis," the pus may find its
way into the bladder and there cause ulceration [in other
words, that pus containing tubercle baccilli may flow down
by way of the ureters and cause tuberculous ulceration of
the bladder]. Paulus' theory regarding the origin of gout,
adds Neuburger, is quite remarkable for that early period.
He maintains, for example, that in persons who lead a
rather inactive life and who are often affected with
digestive disorders, there is produced, through the inade-
quate power of the tissues of the body to assimilate the
excess of nutriment brought to them, a materies morbi
which is drawn first to the parts that a're weakest or least
capable of resistance (the joints, for example) and then
also to other structures, as the liver, spleen, throat, ears
and teeth. These ideas — let it be remembered — ^were set
down in writing in 650 A. D.

At the beginning of his analysis of Book VI., Neuburger
makes this remark: ''Although the description given by
Paulus of the surgery of the ancients is based upon the
writings of Hippocrates and Galen, as well as upon those
of Leonides, Soranus and Antyllus, one finds at every step

MEDICINE IN THE MIDDLE AGES 201

ample evidence that the writer possessed both independence
of judgment and the manual skill which belongs to a physi-
cian who is familiar with surgical work." He calls par-
ticular attention to the section (No. 88) which deals with
the manner of removing the heads of arrows from wounds,
and he gives special praise to Paulus for his most instruc-
tive account of the diagnostic signs to be looked for in a
case of suspected wounding of a vital organ. He is
extremely thorough, says Neuburger, in his teachings
about fractures and dislocations, and he not infrequently
differs from the views expressed by his predecessors.

In the section devoted to gynaecological operations
Paulus makes it perfectly clear that he was in the habit
of using a speculum of a very practical form. Here are
his words: —

and, while the operator is holding the instrument in posi-
tion, an assistant turns the screw until the blades of the instrument
have been separated to the distance desired.

In other chapters of Book VI., Paulus furnishes most
interesting and minute descriptions of a great variety of
operations in general surgery and also in obstetrics,
ophthalmology, otology and rhinology. Those who desire
to learn further details about these surgical matters should
consult the English version mentioned on a previous page.

It is not at all unlikely that at some future day it will
be found desirable — by reason of the discovery of the
treatises which they are known to have written, but which
have been lost — to add to this short list of ancient medical
authors the names of the following men who are frequently
quoted by them in their works: Antyllus, who made some
really valuable additions to our knowledge of the proper
manner of treating aneurysms, and who must have been a
surgeon of great resourcefulness; Leonides, the Alexan-
drian, who lived about the time of Galen, and who appears
to have been highly considered for his practical common
sense in the choice of surgical measures; Hesychios of
Byzantium and his distinguished son. Jacobus Psy-
chrestus, who was highly spoken of by his contemporaries

202 GROWTH OF MEDICINE

(fifth century A. D.), in whose honor a public statue was
erected (Haller), and to whom is attributed the saying:
* * A good physician should either decline at the start to take
charge of a patient, or else he should not leave him until
he shall have brought about some measure of improve-
ment"; finally, Heliodorus, and perhaps a few others who
are less well known.

CHAPTER XVIII

BEGINNING OF THE ARAB RENAISSANCE UNDER
THE CALIPHS OF BAGDAD

Toward the end of the sixth century A. D. the prospects
for the perpetuation and further evolution of Greek medi-
cine looked decidedly dark. In Rome and in the larger
Italian towns of the Roman Empire, physicians were
doubtless still to be found, but they must have led very
precarious lives and they certainly could not have had any
leisure or opportunity for scientific work. In these earlier
years of the Middle Ages the monks conducted the larger
part of whatever medical practice was required in the
districts in which the monasteries were located. In
Byzantium, also, the outlook at this period of Roman his-
tory was very unfavorable ; and nowhere else, as a matter
of fact, would it have been possible for the casual observer
to discover any signs that indicated the approach of a
revival in the study of the sciences. And yet, even at that
seemingly darkest moment in the history of medicine, there
were forces at work which would soon revive these precious
seeds of Greek knowledge, and, after transplanting them
to a richer soil, cause them to produce even better fruit
and in larger quantities than ever before.

The rulers under whose auspices the first steps in the
great Arab Renaissance were taken, belonged to what is
known as the Abbaside Dynasty, the founder of which was
Abbas (566-652 A. D.), the uncle of Mohammed. His
descendants ruled as Caliphs of Bagdad, on the eastern
bank of the Tigris, for many centuries (from 750 A. D.
onward).^ Almansur, the second Caliph of this dynasty,

1 The account which is given in this and the following chapters is based
largely on Dr. Lucien Le Clerc's Histoire de la Medecine Arabe, Paris, 1876.

204 GROWTH OF MEDICINE

felt a very strong desire that his people, the Arabs, should
acquire knowledge of all the useful branches of learning,
and more especially of medicine and philosophy; and
accordingly, as the Greeks were then universally admitted
to be the only nation which possessed that knowledge, and
as scarcely any scientific books written in the Arabic lan-
guage existed at that early date, he directed all his efforts
to the finding of Greek originals and of the men qualified
to translate them into Arabic. Already as early as the
sixth century A. D., Sergius, a Christian of Ras el Ain, had
translated a considerable number of Greek treatises into
the Syrian tongue, but his work was found to be of an
inferior character, and for this reason could not be utilized
to any great extent in the present undertaking. Honein
(ninth century), one of the most eminent scholars of the
Arabic Renaissance, revised a few of these translations
and thus rendered them of some service; but by far the
larger part of this gigantic task of creating Arabic versions
of the classical works of Greek literature, was performed
during the ninth century, a period during which the reign
of the Arabs extended from the Ganges on the east to the
Atlantic on the west. By the end of the eighth century the
work of translating had advanced only to the point of
producing a single treatise on medicine and a few relating
to alchemy ; but before the ninth was completed, the Arabs
had in their possession, in the form of translations, nearly
all the scientific literature of Greece, and, more than this,
they could boast that not a few men belonging to their own
nation had already become celebrated as scientists of the
very first rank.

The medical school at Djondisabour^ at the time (765
A. D.) when the Caliph Almansur decided to carry out the
ambitious scheme which he had been meditating, was
jjractically under the control of a family of Nestorian
Christians. A large hospital formed the nucleus of the
institution and furnished all the material needed for
familiarizing the student with the different diseases and

2 Le Clere and Freind mention both Nishapur and Djondisabour as the name
of the capital of the Province of Khorassan in northeast Persia.

TEE ARAB RENAISSANCE 205

injuries commonly encountered in that part of the world
and with the methods of treatment which, as long experience
had shown, offered the best chances of affording relief or
effecting a cure. It was a clinical school of a most practical
type, and at the head of it was George Bakhtichou, who had
been recommended to Almansur as the physician best fitted
to take responsible charge of the new work which was then
about to begin. George Bakhtichou was not the organizer
of the school at Djondisabour, but simply its head at the
time of which I am now speaking. Medicine had been
taught there, it appears, since the early part of the seventh
century A. D. The languages commonly spoken in that
town were the Syrian, the Arabian and the Persian, and
probably only a few persons understood Greek. The
Caliph believed that, as the first and most important step
in the new work, medical text books, translations of the
works of the best Greek physicians, should be provided with
as little loss of time as possible, and George Bakhtichou
agreed with this opinion entirely. The latter, therefore,
upon the urgent invitation of the Caliph, left the hospital
at Djondisabour in the charge of his son, Bakhtichou ben
Djordis, and went to Bagdad in company with two of his
pupils, Ibrahim and Issa ben Chalata. He was well
received at Court, partly because he displayed a readiness
to further the Caliph's educational plans, and partly also
because he was promptly successful in relieving him of a
distressing dyspepsia. Not long after he had arrived in
Bagdad, however, he was himself taken ill and was obliged
to return to Djondisabour. Before his departure the
Caliph presented him with a gift of 10,000 pieces of gold.
Issa ben Chalata, one of the two pupils whom George
Bakhtichou had brought with him to Bagdad, was left
behind to look after the Caliph's health. He proved
faithless to his trust, however; and, as soon as it was
discovered that he was selling his supposed influence with
the Caliph, he was not only dismissed in disgrace but all
his property was confiscated. After this disagreeable
experience the Caliph did his best to induce George to
return to Court, but the latter was then unable to travel,

206 GROWTH OF MEDICINE

owing to the injuries which he had received from an acci-
dental fall. His pupil Ibrahim went to Bagdad in his
place.

It is known that George Bakhtichou personally took an
active part in the work of translating Greek medical
treatises into Arabic, but it has not yet been ascertained
which books in particular were assigned to his care in the
distribution of the different tasks. Ossaibiah, the Arabian
historian, makes the statement that the work of translating
Greek medical treatises was entirely under the control and
guidance of George Bakhtichou; and in the '^Continens"
of Rhazes frequent mention is made of the latter 's name.
All of which confirms the belief that, at the beginning of
the Arabic Renaissance, George Bakhtichou was in reality
the head and front of the movement, so far at least as
medicine was concerned. When he became too old and
infirm to continue his attendance at the Djondisabour
hospital, he intrusted the management of that institution
to Issa ben Thaherbakht, who was one of his best pupils.
He died in 771 A. D.

In 786 A. D., Haroun Alraschid succeeded to the
caliphate ; and not long afterward, on the occasion of some
temporary illness, he requested Bakhtichou ben Djordis,
the son of George and his successor in the work of trans-
lating from the Greek, to consult with the regularly
appointed physicians of the Court in regard to the nature
and proper treatment of his malady. The consultation
took place at the appointed time, and one of the Caliph's
physicians, thinking that he might catch Bakhtichou in a
trap, submitted to him a specimen of urine which purported
to come from the Caliph, but which in reality had been
obtained from a beast of burden. Alraschid, who knew of
the deception, asked: —

''What remedy would you administer to the person from
whom this urine came ? ' '

Bakhtichou, who had been clever enough to recognize the
true character of the specimen, replied promptly : ' ' Some
oats, your Majesty."

The Caliph laughed heartily over the episode, loaded

THE ARAB RENAISSANCE 207

George's son with presents, and appointed him the chief
of all his physicians, — the first instance among the Ara-
bians, it is said, of the appointment of an Archiater.

Bakhtichou ben Djordis was the author of a collection
of short medical treatises, and he also wrote, for the special
use of his son Gabriel, a medical ** remembrancer. " He
was as highly esteemed by the Arabs as his father had been
before him. The date of his death is not known.

Gabriel, the son of Bakhtichou and a grandson of the
famous George Bakhtichou, was the most distinguished
member of this remarkable family of physicians. In the
year 792 A. D., five years after the consultation mentioned
above had taken place, Gabriel was sent by his father to
give medical advice to Jafar, the son of the Grand Vizier.
The treatment which he recommended proved to be entirely
successful, and, pleased with the result, Jafar soon after-
ward had an opportunity to speak to Haroun Alraschid
of Gabriel as the physician best fitted to effect a cure in
the case of his own favorite wife, who, in a fit of yawning,
had dislocated her shoulder. The Arabian physician had
tried friction, different sorts of ointments, and manipu-
lations of every imaginable kind, but all in vain. The
dislocation still persisted. When Gabriel arrived on the
scene he told the Caliph that he could bring the shoulder
back into place provided no offense would be taken at the
means which he was about to employ. Alraschid gave the
desired promise and Gabriel made a movement as if he
were about to lift up the bed-clothes. Instantly the patient,
through a natural sense of modesty, stretched out her
dislocated arm to keep the bed-covering in place. * * There !
she is cured ! ' ' exclaimed Gabriel, and such indeed was the
truth. The sudden movement of the limb had reduced the
dislocation. — It only remains for me to add that the sum
of 500,000 drachmae^ was paid to Gabriel by Haroun
Alraschid for his successful treatment.

Some surprise having been expressed by the Caliph *s

3 The drachma was a silver coin worth about 9% pence English money. The
fee paid to Gabriel for his surgical services amounted, therefore, to a little less
than £2000 or $10,000.

208 GROWTH OF MEDICINE

relatives that he should display such extravagant gener-
osity toward a Christian, he replied: ''The fate of the
empire is bound up in my fate, and my life is in the hands
of Gabriel."

Gabriel Bakhtichou died in the early part of the ninth
century, not long after the Caliph El Mamoun had started
on his expedition against the Greeks (828 A. D.). He was
the author of several medical treatises, and, like his famous
grandfather, George Bakhtichou, he did everything in his
power to promote the work of translating from the Greek
into the Arabic. Gabriel's brother, also named George,
and his son Bakhtichou ben Djabriel were both of them
physicians of considerable distinction. The latter accom-
panied El Mamoun on his expedition against the Greeks.
It is a fact worth noting here, that throughout this war
the Caliph never for a moment lost sight of the great
national scheme of education which his predecessor
Almansur had inaugurated and which was still engaging
the time and best efforts of many scholars and copyists in
Bagdad. Whenever he captured a city he insisted upon
the delivery to him of whatever copies of scientific treatises
its citizens might possess. But even these extraordinary
methods of securing the books which they needed did not
satisfy the Arabs, their eagerness to accumulate as many
text books as possible being insatiable. Accordingly, from
time to time, one of the translators — some member of the
Bakhtichou family, for example — ^would be sent to the
different cities of Syria and Persia to search out and get
possession of as many Greek manuscripts as possible.
Thus, Honein is reported to have said : ' ' I have not been
able to procure a complete copy of Galen 's * Demonstration. '
Gabriel endeavored to find a copy, but did not succeed ; and
I myself hunted through Irak, Syria, Palestine and Egypt,
but was at last only partially successful. I found one-half
of the text in Damascus."

The work of translation was kept up with unremitting
zeal until the middle of the ninth century (reigns of El
Ouatocq and of Moutaouakkel).

Among the physicians who received their training at the

TEE ARAB RENAISSANCE 209

Djondisabour medical school the Bakhtichous were not the
only ones who attained considerable distinction. John
Mesne the Elder,* for example, who was a Nestorian
Christian and the son of an apothecary, became more
famous than any member of that family. He not only did
his full share of the translating, but he was also a prolific
author and a very faithful and efficient teacher, Galen's
writings furnishing the basis of his lectures. He lived to
be about eighty years of age, his death occurring in 857
A. D. Most of his writings have been lost. Of the twenty
or more which have come down to our time those bearing
the following titles deserve to receive special mention: —

Book of Fevers.

On the Different kinds of Food and Drink.

On Venesection and Scarifications.

On Tubercular Leprosy.

On Abnormal Prominence of the Abdomen.

On Purgative Remedies.

On Baths.

On the Regulation of Diet.

On Poisons and Poisoning.

On Vertigo.

On the Treatment of Sterility.

On Dentifrices and Gargles.

Sabour ben Sahl, whose death occurred in 869 A. D., was
also connected with the hospital at Djondisabour. He was
distinguished on account of his special knowledge of the
properties of simple drugs and their combinations. He
was also the author of the exhaustive formulary known as
Acrahadin Kehir — probably the first one of its kind, says
Le Clerc, of which history makes any mention. This
formulary or dispensatory — of which a large and a small
edition existed — was in general use in all the hospitals,
physicians' offices, etc., of that time.

Still another most distinguished physician and author of
medical treatises received his training at the Djondisabour

4 To distinguish him from Mesufi the Younger, who lived at Cairo, Egypt,
ahout one hundred years later, and who attained considerable celebrity on
account of the treatises which he wrote on materia mediea.

210 GROWTH OF MEDICINE

school — viz., John, son of Serapion (or Serapion the Elder,
as he is commonly called). He lived about the middle of
the ninth century of the Christian era and wrote entirely
in the Syrian language, but at a later date his works were
all translated into Arabic. The smaller of his two most
important treatises, and at the same time the one which
appears to have attracted the most attention, was called
the Kounnach. About the middle of the twelfth century
A. D. it was translated into Latin by Gerard of Cremona,
and named by him Breviarium; a still later translation
received the name of Practica. The first part of this
smaller treatise (the Breviarium or the Practica) is
divided into six books, the titles of which are as follows : —

1. On Nodosities, Ophiasis, and Alopecia.

2. On the Falling Out of the Eyelashes.

3. On the Mild Form of Tinea, the form which resembles Favus.

4. Scaly Affections of the Head and of Other Parts of the Skin.

5. Lice of the Head and of the Body.

6. Headache caused by Exposure to the Sun; and other forms
of Cephalalgia.

Salmouih ben Bayan, a Christian, was the last one of
the pupils of the Djondisabour school who attained con-
siderable celebrity as a physician. When the Caliph
Motassem came to the throne in 833 A. D., he appointed
Salmouih his personal physician and soon became very
much attached to him; leaning upon him more and more
for advice in all sorts of troubles. Salmouih was the author
of several medical treatises, but they have all been lost,
not even their titles are now known to us. When dying
(early in 840 A. D.), he sent word to the Caliph not to put
his entire trust in the medical judgment of Mesne if he
should find it necessary to call upon the latter for advice
in the event of a serious attack of illness. This celebrated
physician was universally admitted to be most learned in
everything relating to medicine, but there were many of
his professional brethren — and Salmouih was among the
number — who did not esteem him so highly as a practitioner.
''The most important thing in medicine," said the latter,

THE ARAB RENAISSANCE 211

*'is to appreciate correctly the intensity of the disease, and
that is something which Mesne, with all his learning, is not
able to do." However, despite the death-bed warning
given by Salmouih to Motassem, this ruler died less than
two years later from the effects of the treatment which
Mesne the Elder, who had been called in to prescribe for
his Highness, had ordered.

In addition to the pupils already mentioned there are a
few others who, according to the testimony of Le Clerc,
reflected some credit upon the institution in which they
acquired their medical training. But enough has already
been said, I believe, to establish the fact that, in this remote
Persian province of Khorassan (to the west of the country
known to-day as Afghanistan), there existed during the
eighth and ninth centuries of the present era a most
efficient medical school, which was entirely managed by
Nestorian Christians, and which sent out into the world
trained physicians of the very highest type.

CHAPTER XIX

FURTHER ADVANCE OF THE ARAB RENAISSANCE
DURING THE NINTH AND SUCCEEDING CEN-
TURIES OF THE CHRISTIAN ERA

During the latter part of the eighth century the Arab
Renaissance, so far at least as the science of medicine
was concerned, was controlled and kept in vigorous life
almost entirely by physicians who were connected with the
school at Djondisabour — one might almost say, by physi-
cians who were members of the Bakhtichou family. To
this family, therefore, belongs the chief credit for the
admirable results attained during this, the first stage of
the Renaissance. But during the ninth century A. D. men
who had not received their professional training at this
famous school came to the fore and gave a fresh and a more
vigorous impulse to the work than their predecessors had
given. Under the Bakhtichous the translating had been
well started, and in addition a few original medical treatises
had been written in the Arabic language. During the
period which followed, however, the translating and copying
became more active than before, and, in addition, several
really valuable treatises were produced by men who wrote
in Arabic, and who were — if not racially Arabs — at least
the adopted sons of that nation. Of these men none stands
out more prominently than Honein, who, according to
Le Clerc, ** accomplished a marvellous amount of work of
the most varied character and of a very high degree of
excellence, and that too despite many obstacles. While
he was not the originator of the Renaissance in the East,
he took the most active part in keeping it up."

Honein, who may rightly be considered as having at
least inaugurated the second stage of the Arab Renais-

THE ARAB RENAISSANCE 213

sance, was born in 809 A. D. at Hira, where his father
Isaac, a Christian Arab, conducted a pharmacy. The
inhabitants of this town were known to be somewhat
lacking in cultivation, and it was therefore not surprising
that, when Honein went to Bagdad and presented himself
to John, the son of Mesue, as one who wished to become his
pupil, his request was promptly declined on the general
ground that the people of Hira had not received sufficient
education to warrant any one of their number in under-
taking the study of medicine. This decision was of course
a great disappointment to Honein, but it disturbed him
only for a short time. Soon afterward he went to Greece
where he worked hard to perfect himself in the knowledge
of the Greek language. Then, after a residence of two
years in that country, he returned to Bagdad, taking with
him a considerable supply of Greek books. His next step
was directed toward gaining a better knowledge of Arabic,
iand with this object in view he spent some time in Bassora,
a town which was situated not far to the south of Bagdad,
and which possessed good educational facilities. While
residing there he devoted a certain portion of his time to
the translation of Galen 's treatise on anatomy ; and he was
accordingly prepared, upon his return to Bagdad, to sub-
mit to John, the son of Mesne, and to Gabriel, the son of
Bakhtichou (who by that time was well advanced in years),
a specimen of the work upon which he had been engaged.
Both of these men were greatly pleased with the excellence
of the translation, and encouraged Honein to go on with
the work. El Mamoun (the second son of Haroun Alras-
chid), who was the then reigning Caliph, engaged his
services both as a translator of Greek writings (into Syriac
as well as Arabic) and as a reviser of the translations
which had been made by others, and he paid him most
generously for these services. According to Le Clerc, the
amount of literary work done by Honein was simply
prodigious. He translated large portions of the treatises
of Galen, Oribasius and Paulus Aegineta, as well as several
of the works of Aristotle and of Plato, of the mathema-
ticians and astronomers, and also of the philosophers ; and

214 GROWTH OF MEDICINE

in addition he wrote a large number of original treatises —
such, for example, as a complete set of commentaries on
the writings of Hippocrates, a practical work on the
diseases of the eyes, etc.

The following account of Honein's experience at the
Court of the Caliph Moutaouakkel (middle of the ninth
century A. D.) furnishes some insight into his character: —

The Caliph, who had heard of the great learning, ability, and
industry of Honein, but who had at the same time feared that he
might be in secret communication with the Greeks, decided to
subject him to a test that would reveal how far he was venal.
Accordingly he sent for him, clothed him in robes of honor, gave
him 50,000 drachmae, and then said:

*'I wish that thou wouldst prepare for me a secret combination
of drugs which will enable me to get rid of one of my enemies. ' '

Honein replied: ''I have no knowledge of any but salutary
remedies, and it never occurred to me that the Prince of Believers
might ask me to furnish those of a different kind. However, if it
be the wish of your Majesty, I will see what I can do ; but I shall
require plenty of time."

After waiting in vain for the desired preparation and finding
that even threats failed to accomplish anything*, the Caliph put
Honein in prison. Then, at the end of a year, which interval the
latter had employed diligently in the work of translating,
Moutaouakkel gave orders for the prisoner to be brought into his
presence. Before this was done, however, a heap of objects of
value was placed on one side of the room and instruments of
torture on the other. When Honein was brought in, the Caliph
said to him : ' ' Time is passing, and my wishes have not yet been
gratified. If thou art now ready to obey my behest, these treasures
and many others in addition shall be thine. But, if thou continuest
to refuse, I will subject thee to tortures and will finally put thee
to death."

"I have already told the Prince of Believers," replied Honein,
"that my knowledge is limited to the preparation of salutary
remedies. ' '

Whereupon the Caliph said: "Have no fear! I simply wished
to test thee! But tell me, what are the reasons upon which thy
refusal is based?"

' ' There are two reasons, ' ' replied Honein : * * my religion and my
profession. The first teaches us to do good to our enemies; and

THE ARAB RENAISSANCE 215

the second, not to do any harm to the human race. Every physician
has registered an oath that he will never administer a poison."

"Those are two excellent laws," remarked the Caliph; and he
proceeded to load Honein with presents.

Among those who were associated with Honein in his
work of translating Greek medical books into Arabic there
are three whose names also deserve to be remembered.
They are : his son Isaac ; his nephew Hobeich ; and a Chris-
tian Greek named Costa ben Luca, whose residence was at
Baalbek. To men of the present time all these names of
oriental physicians are, as a rule, mere meaningless words,
conveying no idea of an important relationship to the
evolution of medicine. During the ninth and tenth cen-
turies of the present era, however, and indeed for many
years subsequent to that time, they were accorded by the
physicians of that period almost as much honor for the
part which they took in furthering the revival of medicine
among the Arabs as was given to Honein himself. It seems
therefore appropriate that at least a brief account of the
lives of these men and of the work which they did should
be given here. .

Isaac received his education from his father Honein, and
soon after reaching manhood he was set to work trans-
lating from the Greek into both Syrian and Arabic — two
sister languages. He was a man of great intelligence, and
was thought by many to be the equal of his father in the
knowledge of Greek, Syriac and Arabic. He also had, like
his father, the good fortune to find favor with the rulers
of that period. He died in 912 A. D. as the result of a
stroke of cerebral apoplexy. In addition to his trans-
lations he wrote original treatises on the following topics : —

Simple Medicaments.

Origins of Medicine.

Correctives of Purgative Remedies.

Treatment by Cutting Instruments.

The means of Preserving the Health and the Memory.

Hobeich was the son of Honein 's sister. The date of his
birth is not known. He received his training in the Ian-

216 GROWTH OF MEDICINE

guages from Ms uncle, and in the course of time became
associated with the latter in the work of translating.
Eventually he reached his uncle 's high standard of scholar-
ship, and the text of his translations was from that time
forth accepted without any revision. The Caliph Mou-
taouakkel appointed him Court Physician, and the imme-
diate successors of this Caliph retained him in the same
position. His death occurred during the second half of
the ninth century of the Christian era.

Hobe'ich translated the ''Oath of Hippocrates" and a
large number of the more important of Galen's treatises.
In addition, he left to posterity several original writings.
Quotations from these are to be found in the works of
Rhazes, of Ebn el Beithar, and of Serapion the Younger,
and they reveal two important facts: first, that Hobeich
was an excellent practicing physician ; and, second, that the
Arabs had already at this comparatively early date begun
to gather their medical information from other sources
than the Greek treatises. The following drugs, for
example, are described by Hobeich in the quotations just
mentioned, and yet they do not appear to have been known
to the Greek medical writers : Turbith, Convolvulus of the
Nile, Nux Vomica, Colocynth, Croton Tiglium, Aloes and
Myrobolans.

Costa, the son of Luca, was a Christian Greek from
Baalbek, in Syria. The dates of his birth and death are
not known, but it is believed that he lived during the first
half of the tenth century of the present era. He was an
excellent Greek and Arabic scholar and was also familiar
with the Syriac language. His translations were esteemed
equal to those of Honein. After spending some time in
Greece he settled in Irak, a province of Persia, and devoted
himself to the translation of the books which he had
brought with him from Greece. At a later period of his
life he removed to Armenia, a country which lies to the
north of Irak, between it and the Black Sea, and it was
during his residence there that he wrote a number of
treatises. It was in Armenia, also, so far as may be judged
from the accounts which we possess, that his death took

THE ARAB RENAISSANCE 217

place. As an evidence of the fact that he was highly
esteemed by his contemporaries, his biographer states that
a cupola was built over his tomb.

Among the medical works which he translated from the
Greek the following are the only ones of special impor-
tance: The Aphorisms of Hippocrates, and Galen's com-
mentaries upon them.

The ninth century, the period during which the major
portion of the work described in the preceding part of this
chapter was accomplished, is considered by Lucien Le Clerc
the most remarkable in the world's history. He speaks of
it in the following terms : —

Its greatness is emphasized by the fact that, except in this one

corner of the globe, everything was in a state of decadence

Great as is the credit due the Abbaside Djmasty and its ministers,
still greater is our admiration for the Arab nation on account of
the eagerness with which it met the wishes of its rulers and also
because it pursued resolutely, and despite all the obstacles
(political and religious) which were placed in its way, the course

laid down for it to follow The Arabs also knew how to

choose men who were really eminent and to rescue them from lives
which otherwise would probably have been sterile; they claimed
the inheritance of Greek science; and they revealed to the world
that they were worthy of this inheritance.

Some idea of the completeness of the list of Greek
medical works which the Arabs translated may be gained
from the fact that Galen's writings are more complete in
the Arabic than they are in the Greek, the language in
which they were originally composed.

With Costa the second stage in the Arab Renaissance
came to an end. All the work accomplished at Bagdad
up to this period in our history received its inspiration
from the different Caliphs belonging to the Abbaside
Dynasty. But now the political conditions in the East
underwent a change, and other Arabian dynasties, each in
its turn, gained control of the power previously wielded
by Almansur, Haroun Alraschid and their successors.
Fortunately, all of these new rulers seem to have been
favorably inclined toward the revival of literature, and

218 GROWTH OF MEDICINE

consequently the Arabs continued to take an active part
in the advance of medical knowledge during the tenth and
eleventh centuries. Bagdad, however, ceased to be the
centre of all this intellectual activity, and eventually
Cordova in Spain almost rivaled the capital of ancient
Greece in the eagerness with which she sought to increase
her stores of books, and in her readiness to honor scholars.
By this time the Arabs controlled, not only Persia and
Arabia, but also Egypt, Palestine, Syria, Marseilles, the
coast of Asia Minor, Greece, Sicily, the northern part of
Africa and Spain. Owing to the limited space at my
command I shall be obliged to confine my account to the
more salient features of the progress made during this
later or third stage of the Arab Eenaissance.

Already as early as toward the end of the ninth century
the number of physicians in the East had increased so
greatly, and the territory where well-educated medical men
were to be found had broadened to such an extent, that I
shall now be obliged, in order to maintain some approach
to chronological order in my account of the evolution of
medical science, to treat the subject according to countries.
If the men who stand out foremost in this third stage of
the scientific renaissance are not in every instance Arabs
or Persians or Syrians, I may at least claim that they are
the product, directly or indirectly, of the great Arab move-
ment. The countries in w^hich their best work was done
are the following: Persia (apart from Bagdad and its
immediate neighborhood), Egypt, Magreb (the modern
Algiers and Tunis ) , Fez and Spain. But, before I consider
the progress of medicine in these different parts of the
Orient, I should say at least a few words about the events
which characterized the cessation of literary work at
Bagdad. As might be expected, that city, after the Greek
medical and scientific treatises had all been translated
into Arabic, gradually lost its pre-eminence as a centre of
learning, and new centres developed in other cities through-
out the vast Musulman Empire. It must not be inferred,
however, that this change was wholly or even largely due
to the cessation of literary work. Other factors contributed

THE ARAB RENAISSANCE 219

to this result, viz. : the decadence of the caliphate and the
fact that the caliphs themselves appeared to lose their
interest in promoting the sciences actively. It was not
until during the tenth century that any further interest
in the advancement of medical science was taken by those
in authority at Bagdad. Then the Emir Adhad Eddoula
built a splendid hospital, and organized it on the basis of
several separate services — one for fever cases, another for
accidental injuries, a third for ophthalmic cases, and so on.
Twenty-four physicians, who had been selected because of
their special aptitude for some particular class of medical
work, were appointed to take charge of the diiferent ser-
vices ; and it is interesting to note that nearly all of these
men bear Arab names. Nevertheless, for a still further
period of many years, says Le Clerc, there continued to be
as many Christian as Mohammedan physicians in Bagdad.

In the tenth century other hospitals were established in
Bagdad. Thus, in 914 A. D., the Vizir Ali ben Issa founded
one which he endowed in the most liberal manner. This
Vizir must have been a most humane person, for, when
the physician-in-charge wrote to him for further instruc-
tions regarding the course which he should pursue mth
respect to people of different religions, the Vizir replied:
*'Use the fund for the benefit of all classes alike, and be
sure to remember the animals."

Persia. — Ehazes, whose full name is Abou Beer Moham-
med ben Zakarya, is generally admitted to have been the
most illustrious of Persia's physicians, and probably the
most distinguished representative of Arab medical learn-
ing. He was born at Raj, in the Province of Khorassan,
about 850 A. D. After he had received his professional
training at Bagdad, he settled at Raj and was soon after-
ward appointed director of the local hospital. At a later
date he was placed in charge of the hospital at Bagdad,
but before many months had elapsed he returned to Raj,
his native town, and here he spent most of the remaining
years of his long life. The date of his death is stated by
Haeser as either 923 or 932 A. D., but Le Clerc mentions
only the latter date.

220 GROWTH OF MEDICINE

Ehazes was a very hard worker and was Mghly esteemed
by his fellow countrymen, who called him the Arabian
Galen. The total number of writings which he left behind
him at the time of his death was 237, most of them dealing
with medical subjects. A few of them, however, were de-
voted to the discussion of chemical, anatomical and philo-
sophical questions. To-day we possess only 36 of the
treatises written by Rhazes, and of this number only six
have been printed in Latin. His greatest work, as all
critics admit, is that which is commonly known as the
''Continens" (or **E1 Haouy")- In this work, which is
divided into twenty-two books, Rhazes gives in a con-
densed form the views entertained by all his predecessors
regarding the more important questions in medical science,
and then adds thereto the conclusions which his own expe-
rience has led him to form.

He also wrote a second treatise (in ten books) which
was esteemed by the physicians of that and later periods
almost as highly as the Continens. It was called the '*Man-
soury," and its contents are distributed as follows: I.,
Anatomy; II., the Different Temperaments; III., Alimen-
tary Substances and Drugs; IV., Hygiene; V., Cosmetics;
VI., the Regimen to be adopted in Traveling; VII., Sur-
gery; VIIL, Poisons; IX., Maladies in General; X., Fevers.

A third treatise of considerable importance is that which
is devoted by Rhazes to the description and treatment of
small-pox and measles. So far as is known at the present
time this is the first treatise that has been written on these
diseases, and its celebrity rests, not only upon this cir-
cumstance, but also upon the facts that its author is evi-
dently familiar with the different types of small-pox and
with the characteristic features which distinguish this dis-
ease from measles. Freind, in commenting upon this
treatise, says that Rhazes assigned for small-pox a cause
"entirely new in physick, a sort of an innate contagion.
This is a ferment in the blood, like that in must, which
purifies itself sooner or later by throwing off the peccant
matter at the glands of the skin; an hypothesis since ap-
plied, though upon very slight grounds, to feavers in gen-

THE ARAB RENAISSANCE 221

eral by many moderns." From this account it is fair to
conclude that Ehazes, in the tenth century of the Christian
era, as clearly suspected the germ origin of certain febrile
diseases as Liebermeister did toward the end of the nine-
teenth, or as Fracastoro did in the sixteenth. And one can-
not help exclaiming: How many centuries had to elapse,
and what an immense amount of other facts had still to
be discovered — facts in anatomy, in physiology, in chem-
istry, in optics, etc. — before it became possible to convert
this suspicion, this simple product of the reasoning faculty,
into an actual demonstration of the truth in pathology!

Among the Arabian physicians of the eleventh century
Avicenna is certainly one who should be placed in the first
rank. He was born in 980 A. D. at Afschena, a village in
the Province of Khorassan, Persia, and spent his youth
in Bokhara, where his father held some high office under
the Government. His great intellectual capacity was re-
vealed at an early age. It is said, for example, that already
before he was ten years old he had committed the entire
Koran to memory; and it is added, further, that when he
was only seventeen years old he had already acquired such
knowledge of medicine that he was invited to take part in
a consultation regarding some malady with which the Emir
Nuch ben Mansur was affected. The advice which he gave
on this occasion was followed, and in the sequel it proved
so good that he was granted, as a reward, unrestricted
access to the royal library, — a privilege which he utilized
to the very best advantage. When his father died Avicenna
came into possession of a large fortune, which enabled him
to indulge in a great deal of traveling. In this way he
visited one Persian Court after another throughout a
period of several years. Finally, during a residence at
Hamadan, the Prince Schems ed-Daula, whom Avicenna
had successfully treated for some malady, made him his
Vizir. While he held this office he managed, without
neglecting his official duties, to continue his scientific
studies ; but he was not able entirely to keep out of political
intrigues, and as a consequence his life was for a short
time in some danger. He was confined for several months

222 GROWTH OF MEDICINE

in a fortress, from whicli, however, he managed eventually
to make his escape to the Court of Ibn Kakujah, in Ispahan.
He resided in that city during the following fourteen years,
and it was there that he wrote his two principal works —
the famous medical treatise known as the *' Canon," and
the equally celebrated cyclopaedic work on philosophy.
Worn out by his incessant and most exhausting literary
labors and by his excesses in other directions, Avicenna
died in June, 1037 A. D., while he was accompanying the
Emir on his expedition to Hamadan. His tomb may still
be seen in the latter city.

Neuburger, from whose excellent History of Medicine
the preceding details have been gleaned, makes the state-
ment that the treatise in which Avicenna 's clinical expe-
rience was recorded has not come down to our time, and
that, consequently, we lack the means of estimating just
how great a physician — just how close a clinical observer
and how wise a practitioner — he really was. So far, how-
ever, as may be judged from the evidence furnished by the
Canon, Avicenna was not the equal, in all practical matters
relating to medicine, of Haly Abbas and of Rhazes. He
was perhaps too much inclined to '4ook at bedside phe-
nomena through the spectacles of preconceived theories.'*
In brief, he was, first and foremost, a philosopher, and only
in a subordinate degree a physician, although a most excel-
lent one. In Book IIL, where he discusses certain surgical
procedures, statements are made which justify the belief
that Avicenna was acquainted with intubation of the larynx.

Le Clerc mentions six other Persians who, during the
tenth century of the present era, gained more or less dis-
tinction as physicians. In the following paragraphs brief
notices are given of each of these men.

Eben el Khammar, born in 942 A. D., was a Christian
and an excellent practitioner. He was well versed in the
science of medicine and a writer of some importance. Date
of death unknown.

Abou Sahl el Messihy, who was also a Christian, was a
contemporary and intimate friend of Avicenna. He died
in 1000 A. D. He was the author of a complete and very

THE ARAB RENAISSANCE 223

useful summary of medicine, entitled ''Kitab el Meya";
and the Arab historian Ossaibiah speaks in terms of ad-
miration of another treatise which he wrote and which
bears the title, '* Exposition of God's wisdom as Mani-
fested in the Creation of Man."

Abou Soleiman Essedjestany, commonly called '*E1
Mantaky." The dates of his birth and death are not
known. He wrote a number of treatises, and — among
others — one on ''The Organization of the Human Facul-
ties."

Aboul Hassan Ahmed Etthabary, a native of Thabaris-
tan, in the Province of Khorassan. He was employed as
a physician by the Emir Rokn eddoula ben Bou'ih, and is
known as the author of a compendium of medicine entitled :
''Hippocratic Methods of Treatment." He died in 970
A. D.

El Comry was one of the most eminent medical prac-
titioners of his time, and was in high favor with the royal
household. He wrote a compendium of medicine which
bears the title ''R'any ou Many," and he was also the
author of a treatise on the causes of disease. His death
occurred toward the end of the tenth century of the Chris-
tian era.

Alfaraby, who is highly commended by Avicenna, should
be classed among the philosophers rather than among the
physicians. He died in 950 A. D.

The sixth Persian physician of some distinction men-
tioned by Le Clerc is Ali ben el Abbas — usually spoken of
as Haly Abbas. The dates of his birth and death are not
stated by any of the authorities, but it is known that he
was a native of Ahouaz, a small town on the Karun river,
to the southeast of Bagdad, and that he was still living
in 994 A. D. Haly Abbas, it is claimed, was the first med-
ical writer who ventured to prepare a complete and sys-
tematically arranged Practice of Medicine. He gave it the
title of Al-Maleky — ''The Royal Book," — and dedicated it
to the Emir Adhad-ad-Daula, whose private physician he
was. It is a much smaller treatise than the "Continens"
of Rhazes, and somewhat more complete than the same

224 GROWTH OF MEDICINE

author's shorter work — the * ' Mansoury. ' * It covers the
entire field of medicine and is distinguished by its very
practical character. It was first translated into Latin in
1127 A. D. X\

Haly Abbas, in one of ms treatises, speaks of Hip-
pocrates in the following terms : * * Hippocrates, who is the
prince of the medical art and the first physician who ever
wrote a book on this art, is the author of many treatises
on all sorts of medical topics .... But he writes in such
a very concise manner that much of what he says is ob-
scure, and as a consequence the reader, if he wishes to
understand him, is obliged to seek the aid of a commen-
tary. ' '

Egypt. — The dynasty of the Fatimides — the descendants
of Fatima (the daughter of Mohammed) and of Ismael, a
great-grandson of Ali, the fourth of Mohammed's succes-
sors— reigned over Egypt for nearly two centuries (10th
to 12th of the present era), and they showed toward the
scientists the same spirit of generosity that had been
manifested toward them by the Abbasides in the earlier
part of their reign. In 970 A. D. Moez Eddoula drove out
the reigning family, assumed the title of Caliph, and
founded the city of Cairo. In 972 he built the celebrated
mosque Al Azhar and constructed, as a sort of annex to it,
a school, a veritable university, where ultimately all the
sciences were taught. It throve vigorously, and students
flocked to it in great numbers from all quarters of the
Moslem empire. During the eleventh and twelfth centuries
Egypt was once more, as it had been in the palmy days of
Alexandria, the home of many excellent and vigorous insti-
tutions of learning. Among the physicians, however, who
received their education in medicine at Cairo during this
long period, there was not one who attained great eminence.

At the end of the eleventh century the Crusaders, under
the leadership of Godfrey de Bouillon and others, made
their first serious attack on Palestine and Syria, and from
that time onward, for about two centuries, they and the
different armies sent out successively from Europe carried
on almost constant warfare, which Michaud the distin-

.^

THE ARAB RENAISSANCE 225

guished French historian (about 1800 A. D.) calls the
product of a pious delirium. Wars of religion are the
most savage and pitiless of all wars, says Le Clerc, and
this was emphatically true of those waged by the Cru-
saders. On the other hand, says the same writer, *Hhe
tolerance exhibited at that period by the Arabs in religious
matters is a well-attested fact, and it owes its origin to
the circumstance that their scientific education was con-
ducted by Christians. Of Saladin's fifteen physicians
two-thirds were either Jews or Christians. Cultivation
and good training were the characteristics of the Arabs at
that period of their history, whereas fanaticism and brute
force were the distinguishing features of the European
soldiers. Several hundred thousand adventurers first
ravaged Europe and then pounced upon Asia. At Antioch
Godfrey de Bouillon committed all sorts of excesses, and
then, when he had taken Jerusalem, he massacred 70,000
of its inhabitants — Jews and Musulmans. Eighty years
later, Saladin retook Jerusalem; and, with the exception
of a comparatively small number, he allowed all of his
captives to go free. His brother, Malek el Adel, paid the
ransom of 2000 of the prisoners. Contrast these fruits of
civilization with the barbarism of the European conquerors
under Godfrey de Bouillon. Another result of the Crusades
was this: The Franks lost a good deal of their savagery
through contact with the Arabs. At a still later period
Western Europe drew a large part of her supplies of knowl-
edge from Spain — i.e., from the Musulmans."

Syria. — In the thirteenth century Damascus, the capital
of Syria, assumed considerable importance as a centre of
medical activity. Bagdad and Cairo had by this time lost
the greater part of their attractiveness for those who
wished to perfect their knowledge of the healing art, and
the vandalism of the so-called Soldiers of the Cross had
put an end for many years to come to all hopes of making
Constantinople once more the home of scientific or artistic
effort. There was one branch of medical practice, however,
in which the Cairo physicians excelled all others — that,
namely, of ophthalmology. This is explained by the well-

226 GROWTH OF MEDICINE

known fact that at all periods of her history Egypt has
been afflicted with ophthalmias to a much greater degree
than any of the other countries of the Mediterranean basin.
The great wealth accumulated in Damascus, the large num-
ber of hospitals which were located in the city, and the
attractiveness of the town as a place of residence undoubt-
edly had much to do with the fact that it attained at this
period so great popularity as a centre of medical activity.

Spain. — During the tenth century of the present era the
Moslem reign in Spain flourished greatly under the two
enlightened rulers of the Ommiade Dynasty — Abdur-
rahman Ennasser and Hakem, and medicine shared fully
in this prosperity. During Abdurrahman's reign the
Emperor Eomanus at Constantinople sent an embassy to
Cordova in Spain, and among the gifts which they took
with them for the Prince, was a copy of the treatise of
Dioscorides in the original Greek, illustrated by marvel-
ously beautiful paintings of the different medicinal plants.
But there was nobody in Cordova at that time who could
read Greek. Accordingly, Abdurrahman begged the
Emperor to send him a man who was familiar with both
the Greek and the Latin tongues, and it was in answer to
this request that the monk Nicholas was sent to Cordova
(951 A. D.). Working in conjunction with several of the
most distinguished physicians of that city he succeeded in
identifying nearly all of the plants mentioned by Dios-
corides.

Among the physicians of Arab, Persian or Jewish ex-
traction who, during the eleventh and twelfth centuries,
practiced their profession in Spain and attained consid-
erable celebrity, the following deserve to receive special
mention here: Abulcasis, Avenzoar, Averroes and Mai-
monides.

Abulcasis. — Abulcasis is universally credited with being
the greatest surgeon of whom the Arabs may rightfully
boast. He was born at Zahra near Cordova in 936 A. D.,
and his death occurred 1013 A. D. Quite early in his pro-
fessional career (before he had reached his twenty-fifth
year) he was appointed one of Abdurrahman's private

THE ARAB RENAISSANCE 227

physicians. Although he owes his reputation chiefly to
the treatises which he wrote on surgery Abulcasis was also
the author of several medical works. He published a col-
lection of all his writings under the title of ''The Tesrif,"
which is divided into thirty parts or books, and which —
according to Lucien Le Clerc — constitutes a veritable ency-
clopaedia. During the course of the twelfth century
Gerard of Cremona translated into Latin the part relating
to surgery; it is not known at what time or by whom the
remainder of the collection was translated. The author's
name in the Latin edition is given, not as Abulcasis, but
as Alsaharavius.

During the lifetime of Abulcasis his writings, and espe-
cially his work on surgery, were not very highly appre-
ciated in Spain. This was largely due to the fact that the
Mohammedan inhabitants of that country did not look
upon surgery with any degree of favor. The Arabs of the
East held Abulcasis in much greater honor. Guy de
Chauliac, the famous French surgeon of the fourteenth
century, in his treatise on surgery, quotes Abulcasis no
less than two hundred times. Le Clerc, in the course of his
remarks upon the value of the surgical treatise written by
Abulcasis, says: ''This book will always be considered,
in the history of medicine, to represent the first formal
and distinct scientific treatise on surgery." At the same
time, the prevailing testimony makes it appear that the
book contains only a small portion of original matter, a
large part of its substance having been borrowed from
the work of the Greek author, Paulus Aegineta. Its chief
merit consists in the orderly and very clear manner in
which the facts are presented, and doubtless the popu-
larity of the book was materially increased by the fact
that many of the instruments required for the different
operations were illustrated pictorially.

Lucien Le Clerc has published (Paris, 1861) a French
translation of Abulcasis ' Treatise on Surgery, and on page
71 of this version the following statement will be found : —

you may also introduce into the cannula a specially

adapted piston in copper, or a stylet the end of which is armed

■^-

228 GROWTH OF MEDICINE

with cotton. Then fill the cannula with oil or some other suitable
fluid, introduce into one end the stylet armed with cotton, and
push it onward until the liquid enters the ear.

Edouard Nicaise, commenting on these words in his
version of Guy de Chauliac's La Grande Chirurgie (page
690), says that they constitute the first reference, thus far
discovered in medical literature, to the use of the instru-
ment known as a syringe.

Avenzoar. — ^Avenzoar was born in Seville, in the south-
ern part of Spain, during the latter part of the eleventh
century. The exact date is not known. His father was
a physician of some distinction, and his son also attained
considerable eminence in the same profession. According
to Neuburger, Avenzoar died, at an advanced age, in 1162
A. D., and was buried in Seville.

It is said that in actual practice Avenzoar, who was a
man of some wealth, confined himself to consultation work.
He considered it beneath the dignity of a physician to
prepare drugs, to apply leeches, or to perform certain
surgical operations — as, for example, lithotomy; but
Le Clerc seems disposed to believe that Avenzoar did not
adopt this view until after he had become somewhat cele-
brated and had accumulated a fortune. Neuburger ranks
him next to Rhazes as a clinical observer and a practitioner
of sound common sense, and he speaks of his great medical
work, the Teissir, as a treatise that abounds in most inter-
esting histories of cases of disease. Among these will be
found the account of an attack of mediastinitis which
occurred in his own person, and which ended in suppuration
that found a vent for its products by way of one of the
bronchi.^ As this disease is of rare occurrence, and as
Freind's account of the attack is presumably a translation
of the original report in Arabic made by Avenzoar, its
reproduction here may be interesting. I shall take the
liberty of modernizing the text very slightly and of
abbreviating it in one or two places.

1 For further remarks concerning the origin of the Teissir see page 229.

THE ARAB RENAISSANCE 229

I felt some pain in the region of the mediastinum (the membrane
which divides the thorax in the middle) while I was on a journey.
As it increased a cough developed, and I observed that my pulse
was very hard and that I had an acute fever. On the fourth night
I took away a pint of blood, but this gave me very little relief.
Being obliged to travel all day I was much fatigued when I retired
at night, and I fell asleep. During my sleep the bandage on the
arm came off, and when I awoke I found the bed deluged with
blood and my strength greatly exhausted. The next day I began
to cough up a sanious matter, and my mind wandered at times.
Gradually all the symptoms subsided and I recovered my health.
Although I partook of large quantities of barley water, I believe
that my recovery was not due to this, but rather to the great loss
of blood which I had experienced.

Freind adds that ''Avenzoar not only takes notice of an
abscess in the mediastinum, but in the pericardium like-
wise; which I don't find had been described or even ob-
served by any of the Greeks or Arabians : and there is no
doubt but this membrane and the mediastinum to which
it is contiguous, are subject, as well as the pleura and lungs,
to an inflammation."

It is one of the distinguishing features of Avenzoar's
character that, in his writings, he does not hesitate to
differ from his predecessors whenever he believes that
their views are erroneous.

Averroes. — Averroes was one of Avenzoar's most dis-
tinguished pupils. Indeed, the latter 's famous work, the
Teissir, is dedicated to Averroes. Thanks to the distin-
guished French historian and philosopher, Ernest Renan,
our knowledge of Averroes has been greatly expanded
since 1852. Averroes was born at Cordova in 1126 A. D.
His father and his grandfather had both held the office of
Cadhi (Alcalde, in Spanish), and were therefore people
of importance in that city. His studies were confined at
first largely to philosophy, and when he reached mature
age he gained a great reputation as the commentator and
interpreter of the writings of Aristotle. Still later in life
much of his attention was devoted to medicine, and he
wrote a book which bears the title **Kitab al-kullidschat"

230 GROWTH OF MEDICINE

(General principles of Medicine). Among the physicians
of the later Middle Ages this work was commonly spoken
of as the **Colliget" (from kullidschat), and was almost
as highly esteemed as the Canon of Avicenna. The idea
of writing a treatise on the individual diseases was first
entertained, among Arabian physicians, by Averroes; but
on reflection he abandoned the idea, and, instead, urged
Avenzoar, his friend and former instructor, to undertake
the work in his place. It was in this way that the Teissir —
the finest work on the practice of medicine produced by an
Arab writer — came to be written.

The topics treated in the ''Colliget" are distributed
throughout the seven books in the following manner: —

Book I. Anatomy.

Book II. Health (Physiology).

Book III, Diseases,

Book IV. Signs or Symptoms,

Book V. Remedial agents and Foods.

Book VI. The Preservation of Health.

Book VII. The Treatment of Diseases.

Neuburger speaks of the ''Colliget" as a fine piece of
philosophical writing, but adds that it is not at all suited
to the needs of the practical physician. Indeed, he doubts
whether any person who has not received a thorough train-
ing in natural philosophy — the philosophy of Aristotle —
would be able to follow the author intelligently.

Maimonides. — Maimonides, who is ranked by Le Clerc
as the greatest Jew, after Moses, of whom the history of
that nation makes mention, was born at Cordova, Spain,
in 1135 A. D. In early youth his teachers were his father
and a disciple of Ebn Badja. At the age of thirteen, and
from that time until he had reached his thirtieth year, he
was obliged under the pressure of circumstances, to pro-
fess, at least outwardly, the faith of Islam. Death or
banishment was the only alternative. During the inter-
vening period of seventeen years he devoted himself
exclusively to his studies. In 1160 A. D. he accompanied
his family to Fez, Morocco, and five years later he settled

TEE ARAB RENAISSANCE 231

at Fostath, near Cairo, Egypt. As a means of gaining Ms
livelihood he engaged in the business of trafficking in
precious stones, continuing his studies at the same time
and carrying on a certain amount of medical practice. Not
long afterward he gained the favor of the Vizir El Fadhl
Beissany, the friend of Saladin, Sultan of Egypt and
Syria, and was by him appointed one of the Court physi-
cians. This enabled him to give up entirely his commercial
business. He prospered in the practice of medicine and
was very highly esteemed in the community in which he
lived. His death occurred in 1204 A. D.

Among the books which he wrote (generally in Arabic)
on medical subjects, the following deserve to receive special
mention : —

I. Commentary on the Aphorisms of Hippocrates.
II. A work known as "Aphorisms of Maimonides" (borrowed

partly from Hippocrates and partly from Galen),
HI. Resume of the writings of Galen.
IV. A letter relating to the subject of personal hygiene.
V.-IX, Treatises on asthma; on hemorrhoids; on venoms and
poisons in general ; on drugs ; and on forbidden articles
of diet.
X. A translation of one of Avicenna's works.

Neuburger speaks in very favorable terms of the medical
writings of Maimonides, and adds that he also wrote a
treatise which bears the title: ** Guide to Those in Per-
plexity"— a work which aims to reconcile reason and faith.
The book has been translated into French by Munk; and
the treatise on poisons has also been translated into the
same language by J. M. Rabbinowicz (Paris, 1867).

Speaking of the remarkable manner in which philosophy
and medicine had flourished in Spain during the tenth and
eleventh centuries, under the reigns of Haken II. and his
successors, Ernest Renan says :

The love of science and of things beautiful had established, in
that privileged corner of the world, a degree of tolerance that can
scarcely be matched in modern times. Christians, Jews, Musul-
mans all spoke the same language, sang the same poems, and took

232 GROWTH OF MEDICINE

part in the same literary and scientific studies. All the barriers
which commonly separate men were thrown down, and all worked
with equal zeal in behalf of our common civilization.

"With the death of Averroes (1198 A. D.), however, Arab
philosophy lost its last representative, and the Koran
resumed its full authority over freedom of thought. In the
succeeding period of decadence (thirteenth century of the
Christian era) there were no physicians of first importance,
at least in Spain and Persia ; and even in Egypt and Syria,
over which reigned at this time the enlightened family of
Saladin, the leading physicians were not of the same
calibre as the men whose names I have just mentioned.
Bagdad and Cordova had by this time become cities of less
importance than Damascus, and botany and ophthalmology
were esteemed of greater value in the scheme of medical
education than at any previous time. It will not appear
strange, however, that medicine should have stood still
during this later part of the Middle Ages if we bear in mind
the fact that warfare was then such a frequently occurring
event that nobody had either time or inclination for scien-
tific studies. The invasions of the Mongolians and the
Crusaders were most disturbing factors.

During the twelfth century of the present era there
were — so we are assured by Le Clerc — women physicians
among the Arabs in Spain. It is said, for example, that
Abou Bekr, a distinguished medical practitioner of that
period, had a sister who was well trained in medicine, and
that it was she who acted as midwife at all the confinements
of the wives of the Caliph Almansur. After her death her
niece officiated in the same capacity in her place. There
can scarcely be any reasonable doubt that, almost from
time immemorial, women as well as men have taken active
part in the practice of medicine.

According to Puschmann, Spain possessed, during the
twelfth century of the Christian era, seventy public libra-
ries and seventeen institutions for instruction in the higher
branches of learning. Among the residents of the city of
Cordova there were, during the same period, no fewer than
one hundred and fifty authors; and the smaller cities of

THE ARAB RENAISSANCE 233

Almeria, Murcia and Malaga could each claim propor-
tionally an equally large number, viz., fifty- two, sixty-one
and fifty-three.

The Effects of the Arab Renaissance as a Whole upon
the Evolution of Medicine. — Although the series of events
which I have endeavored to sketch here in brief outlines
reveals an extraordinary degree of zeal and persistence
on the part of the Arab rulers and their subjects to endow
the nation with the knowledge and skill of their models, the
Greeks, the final results gained, at least so far as they relate
to the evolution of medicine as a whole, were not very
great. The movement lasted for five or six centuries, but
nevertheless only a few relatively unimportant facts were
added by the Arabs to the stock of knowledge which was
possessed at the time of Galen's death. Alhazen's bril-
liant researches in the eleventh century of our era in optics
(more particularly with reference to refraction) paved the
way for a more perfect knowledge, in modern times, of the
physiology of vision; Geber, who lived during the eighth
century of the Christian era, and who is spoken of by
Le Clerc as '* occupying the same place in the history of
chemistry that Hippocrates does in the history of medi-
cine," laid the foundations of that important branch of
science; Abulcasis discovered the Medina worm {dracun-
culus Medinensis) and wrote an excellent description of
the pathological effects which it produces when it lodges
under the skin of a man's leg; and, finally, our pharma-
copoeia was enriched, during these centuries, by the
addition to it of a number of new drugs and pharmaceu-
tical preparations. These are among the more important
contributions which the Arabs made to the general stock
of medical knowledge. On the other hand, they contributed,
in an indirect manner, to the advance of the science of
medicine. From the thirteenth century onward, for a long
period, the Latin language was destined to serve as the
vehicle by means of which all scientific knowledge was to
be spread abroad in the countries which are now known as
Italy, Spain, France, Switzerland, Germany, Belgium and
Holland, and therefore an immense amount of translating

334 GROWTH OF MEDICINE

had to be done before the works of Hippocrates, Galen and
other Greek medical authors could be brought within reach
of the physicians of these different countries. At that late
date it was by no means always feasible to get possession
of an original copy of one of these classical treatises, and
consequently in such cases it became necessary to employ
an Arabic version in the place of the Greek original.
It was in this indirect manner, therefore, that the
Mohammedan Renaissance contributed most effectively
in advancing the development of medical science in general.
One cannot dismiss the subject of Arabic medicine with-
out calling attention once more to the spectacle which this
remarkable Renaissance offers — that of an entire nation
deliberately working to educate itself up to the level of
such intellectual and artistic giants as the ancient Greeks ;
a work which continued with unabated zeal throughout
several centuries in spite of obstacles and discouragements,
and which never ceased for a moment. It is a spectacle
without parallel in the world's history.

CHAPTER XX

HOSPITALS AND MONASTERIES IN THE MIDDLE

AGES

Long before the Christian era it was the practice among
the Greeks to make suitable provision for those who, by
reason of poverty or illness, were unable to provide for
their own wants or to secure the services of a physician.
Their slaves, for example, were sent, when overtaken with
illness, or when they had become too feeble to work, to
what was termed Xenodochia — institutions where they
received kindly care and such medical treatment as was
necessary. (Mommsen.) In strong contrast with this
humane practice stands the action of those wealthy Roman
property owners who, adopting the course recommended
by Cato, the famous censor (96-46 B. C), ''sold their slaves
when they became old and feeble or ill, as they would old
iron, or oxen that can no longer be utilized for work."
This cruel practice not only continued throughout a period
of nearly three centuries, but apparently became more
and more common, for we are told that the Emperor
Claudius (268-270 A. D.) was obliged, in order to mitigate
the evil, to issue a decree that, when a slave was driven
out of the house by his owner, he should be declared free.

Hospitals and Other Kindred Institutions. — Toward the
end of the fourth century of the present era the first
hospital was established in Rome by the widow Fabiola,
a member of the distinguished Fabian family, and her
example induced other wealthy Roman ladies to found
similar institutions. But already several years before this
time the influence of Christianity had made itself felt so
strongly in the eastern branch of the Roman Empire that

236 GROWTH OF MEDICINE

the Emperor Julian, who had previously been among its
most bitter opponents, was forced to say, in one of his
letters : —

Now we can see what it is that makes these Christians such
powerful enemies of our gods; it is the brotherly love which they
manifest toward strangers and toward the sick and the poor, the
thoughtful manner in which they care for the dead, and the purity
of their own lives.

Moved by these considerations, he decided forthwith to
erect hospitals in all the cities of the empire. We do not
know whether he acted upon this resolution or not, but it
is a matter of record that St. Basil, Bishop of Caesarea
(370-379 A. D.), founded in that city, which is about thirty
miles distant from Jerusalem, a settlement composed of
numerous dwellings that were devoted to the use of the
poor and the sick. This institution was managed in an
admirable manner, a special corps of physicians and nurses
being assigned to the duty of caring for its inmates. At
Edessa, the capital of Northern Mesopotamia, another
hospital was founded in 375 A. D. The date of the estab-
lishment of the celebrated hospital at Djondisabour in
Persia, of which mention is made elsewhere (see page 204
et seq.), is not known. About the middle of the sixth cen-
tury of the present era, Childebert I., King of the Franks
and son of Clovis, founded at Lyons, France, the Hotel-
Dieu, a hospital which has afforded shelter and comfort
to thousands of human beings during the past fourteen
hundred years, and which is in active operation at the
present time ; a hospital, too, which has served as a training
school for a long line of distinguished physicians, surgeons
and gynaecologists. It is an interesting fact that Childe-
bert intrusted the management of this great institution to
laymen (instead of the ecclesiastical powers). Finally,
toward the end of the sixth century, Bishop Masona
founded in Merida, Spain, a hospital in which Jews, slaves
and freemen were received and treated on the same foot-
ing ; and he laid down the rule that one-half of the moneys
and other gifts received by the church was to be devoted to

HOSPITALS AND MONASTERIES 237

the maintenance of this institution. The list of hospitals
and other charitable organizations which were established
in these early centuries is very long, and it reveals the fact
that in every known land there existed, throughout these
years, a strong wish to give aid and comfort to the poor,
the sick and the helpless. The Musulmans appear to have
been as zealous as the Christians in promoting works of
this kind; for the records show that in Bagdad, Cairo,
Damascus, Cordova and many of the other cities which
were under their control, they provided ample hospital
accommodations. Indeed, one of the largest and most
perfectly equipped institutions of this character of which
the history of the Middle Ages furnishes any record, was
that planned and constructed at Cairo, Egypt, in 1283
A. D., by the Sultan El Mansur Gilavun. While it was
building, the workmen employed were not permitted to
engage in any undertaking for private citizens, and the
Sultan himself never failed to visit the spot every day
during the progress of the work. The site chosen was that
of one of the royal palaces, and in tearing down this
structure, in order to make room for the new building, the
workmen brought to light a large chest filled with gold and
precious stones, the value of which was sufficient to pay
the entire expense of erecting the hospital. Upon the
completion of the building and the equipment of its spacious
wards in the most perfect manner possible, the Sultan
expressed himself in the following terms: —

I have founded this institution for people of my own class and
for those who occupy an humbler station in life — for the king and
for the servant, for the common soldier and for the Emir, for the
rich man and for the poor, for the freeman and for the slave, for
men and also for women. I have made ample provision for all
the remedial agents that may be required, for physicians, and for
everything else that may prove useful in any form of illness

One of the characteristic features in the management of
this hospital, says Le Clerc, was the custom of giving to
each of the poorer inmates, when he left the institution,
five pieces of gold, in order that he might be spared the

238 GROWTH OF MEDICINE

necessity of undertaking immediately work of an exhausting
character.

Monasteries in Their Relation to Medicine. — While at
first these institutions were designed chiefly as places of
refuge from the turmoil of the world and from the violence
of frequent warfare, it became evident in the course of
time that the evils incident to such a secluded and self-
centered life hindered rather than promoted the develop-
ment of those particular virtues which Jesus Christ urged
his followers to cultivate. This experience led to the
adoption of a different kind of cloister life ; and so it came
about, as stated by Neuburger, that in 529 A. D. Benedictus
of Nursia founded, at an isolated spot high up on the slope
of Monte Cassino, in Campania, Italy, the now famous
parent monastery of the Benedictine Order. According
to the original regulations of this order, the monks were
obliged to perform every day a certain amount of manual
labor as well as devotional exercises. Nine years later
Cassiodorus, who had for a long period been a sort of
Secretary of State under Theodoric the Great and his
successors, became a monk, and, from that time to the day
of his death, * ' devoted all his energies to the service of God
and the advancement of science. ' ' He secured a house not
far from the Benedictine monastery on Monte Cassino,
gathered together there a considerable library, and made
it a rule of the place that the copying of original codices
(the majority of them theological) constituted the most
useful and honorable form of manual labor. A few years
later, this smaller establishment was made a part of the
monastery at Monte Cassino, and the rule just mentioned
was thereafter adopted by the enlarged institution. But
the care of the sick, the feeble, and children was the par-
ticular work which Benedictus, the founder of this institu-
tion, had most at heart. Cassiodorus went even farther
and urged upon the brethren the desirability of studying
the healing art and of utilizing, for this purpose, the works
of ancient medical authors.

Learn all you can, he said, about the characteristics of different
plants and about the methods of preparing medicinal mixtures,

HOSPITALS AND MONASTERIES 239

but set all your hopes upon the Lord who is the preserver of our
lives. In your search for knowledge about drugs consult the
herbarium of Dioscorides, who has described and pictured the
different herbs with great accuracy. Afterward read Latin trans-
lations of the works written by Hippocrates and by Galen, par-
ticularly the latter 's treatise on therapeutics, the one which he
addresses to the philosopher Glaucon; and, in addition, study the
work of Caelius Aurelianus on the practice of medicine, that of
Hippocrates on medicinal plants and methods of treatment, and
some of the other writings on medicine which you will find in my
library and which I have left behind me for the benefit of my
brethren in this institution.

The advice given by Cassiodorus was heeded, not only
by those to whom it was addressed, but also by many suc-
ceeding generations of monks. Even at the present time,
says Neuburger, the books which Cassiodorus recommended
are still to be found, either in the form of original manu-
script copies or in that of translations, in the library of
the parent institution. Furthermore, when it is remem-
bered how large a number of affiliated Benedictine monas-
teries were established in different parts of Europe, it will
readily be appreciated that the good accomplished by the
advice which Cassiodorus gave must have been very great.

Among the later abbots of Monte Cassino there were
three who attained considerable distinction as physicians.
They were Bertharius, who wrote two treatises on medical
topics; Alphanus II., Archbishop of Salerno, who was
celebrated both as a physician and as a poet ; and Desiderius
(1027-1087 A. D.), who was skilled, not only in medicine,
but also in jurisprudence, and who was elected Pope under
the title of Victor III. The monastery attained the height
of its celebrity at the time when Constantinus the African
became one of its regular members. Although Constan-
tinus was a native Arab (born at Carthage about 1018
A. D.), he became converted to Christianity quite early in
life. It is said that he was a great traveler as well as a
great scholar, and that he devoted several years to visiting
foreign lands — Babylonia, India, Egypt and Ethiopia. It
was in this way that he became so well versed in the Ian-

240 GROWTH OF MEDICINE

guages of the East. Upon visiting Spain as a fugitive
from his native city, he took with him several of the works
of Hippocrates and Galen, and in course of time translated
them into Latin. Finally, he accepted the position of
secretary to Robert Gruiscard, the first Norman Duke of
Calabria and Apulia, who appears to have selected Salerno
as his place of residence. At the same time he became one
of the teachers at the medical school of that city, and served
in this capacity for a certain length of time ; but, at the end
of a few years, he was formally accepted by the Abbot
Desiderius as a member of the Monte Cassino community,
and it was here that he did the larger part of his literary
work. His death occurred in 1087 A. D., the same year in
which the Abbot Desiderius — or, rather, Pope Victor III. —
died.

Constantinus was a prodigious worker, but it is doubtful
whether he did anything of an original character. Not a
few of the treatises which were, at that time, credited to
him as original productions, are now known — thanks
largely to the researches of the great French historian and
linguist, Daremberg — to be simply translations from the
Arabic.

It is believed by some authorities that at Monte Cassino
medicine was taught to laymen as well as to those who were
preparing to become members of the Benedictine Order
of monks. It is not likely, however, that this was done
to any great extent, as much better facilities for acquiring
knowledge of medicine were available at Salerno in the
near neighborhood.

In some parts of Gaul, in the early Middle Ages, physi-
cians received very little consideration; indeed, to us
moderns it seems strange that any one should have pos-
sessed sufiicient courage to accept the responsibility of
prescribing for a member of one of the royal families. It
is related by Neuburger, on the authority of Gregory of
Tours ' History of the Franks, that when Austrichildis, the
wife of King Guntram (sixth century A. D.), was ill with
the plague and perceived that her death was near at hand,
she sent for her husband and extracted from him a

HOSPITALS AND MONASTERIES 241

promise that he would behead the two physicians, Nicolaus
and Donatus, who had treated her and whose prescriptions
had failed to effect a cure. Her wish was carried out, in
order — as the statement reads — *Hhat her Majesty might
not enter the Realm of the Dead entirely alone." Many
centuries later, however, when civilization had certainly
advanced far beyond the stage which it had reached in Gaul
in the sixth century of the present era, there were instances
in which able and conscientious physicians were subjected
to equally cruel treatment for their failure to effect a cure.

It was at about this same period, as is amply verified
by the statements made by Bishop Gregory of Tours, that
faith in the power of saintly relics to heal diseases became
almost universal. So great was the effect produced upon
the minds of the people by the public display of these
objects — bones of saints, portions of their grave-stones,
etc. — that a large number of marvelous cures were reported
as the result of such displays; and doubtless — so great is
the power of suggestion over the human mind — many of
these reports were true. A century later (673-735 A. D.),
the Venerable Bede, author of the famous work entitled
*' Ecclesiastical History of the English Nation," gave, in
the course of his narrative, an account of a case of aphasia
in which * ' a remarkable cure was effected ' ' ; and, although
he mentions a course of ** systematic exercises in speaking"
as the means used to effect that cure, he attributes it to
supernatural causes and not to the practical treatment
adopted. He also describes some of the epidemics of his
time, and gives most interesting though brief accounts of
the methods of treatment employed by the priests and the
monks.

During the ninth and tenth centuries, as we learn from
the very full descriptions given by Neuburger in his History
of Medicine, much zeal was manifested by the monks at
St. Gall in Switzerland, at Reichenau in Saxony, and at
Fulda, in Hesse Nassau, in the study of the different
branches of knowledge, medicine included. The following
are the names of those monks who attained the greatest
distinction in this work: Hrabanus Maurus, Abbot of the

242 GROWTH OF MEDICINE

Fulda Monastery, afterward Archbishop of Mayence, and
the author of an encyclopaedia in which the science of
medicine receives quite full consideration; and Walahfrid
Strabo, a pupil of Maurus, Abbot of Reichenau, and the
author of a treatise in verse on medicinal plants.

CHAPTER XXI

MEDICAL INSTRUCTION AT SALERNO, ITALY, IN
THE MIDDLE AGES

The date of origin of the Medical School at Salerno is not
known, but such evidence as we possess shows without a
doubt that already in the earliest part of the Middle Ages
some sort of facilities for studying medicine were provided
in that little town — the Civitas Hippocratica, as it was
called at a later period. It seems to be the general impres-
sion, says Daremberg, that during those early centuries
only ignorance and superstition prevailed in Italy and
Gaul ; in other words, that all desire for scientific research
had vanished, and that there no longer existed such a thing
as the regular practice of medicine. This impression, he
adds, is erroneous. History shows that schools modeled
after those established by the Merovingian and Carlo-
vingian kings (448-639 A. D.), existed up to as recent a
date as the middle of the seventh century, and that subse-
quently the bishops organized the teaching in such a manner
that it should be entirely under their control. As time
went on, however, the schools assumed a more public
character, although the actual teaching was still carried
on in the cloisters and church edifices. It is well known,
furthermore, that the chief of the Ostrogoths, Visigoths
and Lombards — the so-called Barbarians, who at that time
occupied these parts of Europe as conquerors — showed
themselves on many an occasion to be the enlightened
protectors of public instruction and the enthusiastic
admirers of classical literature and science.

At Milan there is preserved a manuscript which furnishes satis-
factory proof that the writings of Hippocrates and Galen were

244 GROWTH OF MEDICINE

made the subject of public teaching at Ravenna toward the end
of the eighth century of the present era And the tran-
scribing of medical manuscripts was known to be carried on at the
Monastery of St. Gall, in Switzerland, during the eighth cen-
tury It is plain, therefore, that throughout those extensive

regions which previously had formed a part of the Roman Empire,
but which during the Middle Ages were under the dominion of
Barbarian kings, there was never an entire lack of physicians, or
of medical knowledge, or of facilities for teaching medicine.
(Daremberg.)

In the light of these statements it is easy to believe that
the original development of the Medical School at Salerno
was a perfectly natural event like that of the founding of
any of the medical schools of a more recent date. The
remarkably healthy and singularly attractive character of
the spot where the town of Salerno is located ; the proximity
of mineral springs ; the comparatively short distance which
separated it from such important centres of population as
Naples and the cities of the Island of Sicily, and from the
famous Benedictine Monasteries at La Cava, Beneventum
and Monte Cassino; and the circumstance that a Ducal
Court was established there — all these are facts which
amply explain both why a medical school was founded here
rather than at some other spot, and why physicians of
exceptional ability were easily induced to make the place
their home. At no time in the history of the school, it is
important to state, do the church authorities appear to have
been in control of its affairs. At most, one or two of the
monks seem to have taken part in the teaching for limited
periods of time ; but in its main characteristics the school
may truthfully be described as an institution created and
managed by physicians for the advancement of medical
science and the best interests of the profession as a whole.*
The organization of hospitals and their utilization for
purposes of clinical instruction must have been the most
important events which followed next in order. It is only

* According to tradition the medical school at Salerno was founded by four
physicians — Adela, an Arab; Helinus, a Jew; Pontus, a Greek; and Salernus,
a Latin.

MEDICAL INSTRUCTION AT SALERNO 245

upon this assumption that we can satisfactorily explain
why, for many years in succession, physicians traveled all
the way from France, Germany and England to Salerno.
They were eager to gain additional knowledge of medicine,
and clinical instruction afforded the only sure way of
obtaining it ; but instruction of this kind was nowhere else
to be obtained at that remote period, and consequently men
of this earnest and ambitious stamp were compelled to
make the long journey and to incur the expense and the
risk incident to such a trip. As a further evidence of the
value which the physicians of the later Middle Ages set
upon the writings of the teachers at Salerno, the fact
deserves to be mentioned that, toward the end of the twelfth
century and all through the thirteenth and fourteenth
centuries, these works were frequently quoted.

But the ability and learning of the Salerno physicians
were highly appreciated by the public at large as well as
by their confreres in other lands ; for many people of wealth
and of high social standing visited Salerno for the purpose
of consulting them. Among the number were Adalberon,
Bishop of Verdun, France, who journeyed thither in 984
A. D., but failed to obtain the relief which he required;
Desiderius, the Abbot of Monte Cassino; Bohemund, the
son of Duke Robert Guiscard ; and William the Conqueror,
afterward King of England. The two last named remained
for some time in Salerno, in order to secure needed treat-
ment for the wounds which they had received in battle.

Toward the end of the tenth, or at the beginning of the
eleventh, century the teaching of medicine at Salerno began
to assume the character of regularly organized work. The
names of the men and women who conducted it — for there
were women as well as men in the corps of teachers — are
mentioned in various contemporaneous documents which
have come down to our time. They are as follows:
Petroncellus, Gariopuntus, Alphanus, Bartholomaeus,
Cophon, Trotula, John and Matthew Platearius, Abella,
Mercuriade, Costanza Calenda, Rebecca Guarna, Aflflacius,
Maurus, Musandinus and many others. According to
Puschmann, the list of physicians who, during the exist-

246 GROWTH OF MEDICINE

ence of the Medical School at Salerno, — a period of nearly-
one thousand years, — acted as teachers in the institution,
comprised no less than 340 names. The presence of several
women among the instructors of this school, and the great
esteem in which they were held by the men of that time,
both for their ability as practitioners and for the excellence
of the treatises which they wrote, furnish strong confirma-
tion of the statement which Plato makes in his work
entitled ' ' The Eepublic, ' ' and which I have already quoted
in one of the earlier chapters, viz. : * ' For women have as
pronounced an aptitude as men for the profession of
medicine." And, if further evidence of the correctness of
Plato's opinion were needed, the success attained by
women physicians during the past thirty or forty years in
the United States of America might be cited.

To the general statement made above I may with
advantage add a few details regarding both the individual
physicians at Salerno and the books which they wrote.
During recent years, thanks to the researches of Henschel,
de Eenzi and Piero Giacosa, our knowledge of these matters
has been greatly enlarged. In 1837 Henschel found, in the
library at Breslau, Germany, a manuscript collection of
Salerno medical treatises ('* Compendium Salernitanum")
dating back as far as the latter part of the twelfth century
of the present era. De Eenzi, working in association with
Daremberg and Baudry de Balzac, succeeded in collecting
from the different libraries of Italy quite a large number
of additional Salerno treatises, all of which have since been
published under the title ^^Collectio Salernitana, ossia
documenti inediti e trattati di medicina appartenenti alia
scuola medica Salernitana'^ (5 vols., Naples, 1852-1859).
Finally, Piero Giacosa has added to this stock of Salerno
writings by the publication (Turin, 1901) of a work which
bears the title '^Magistri Salernitani nondum editi etc.''
Beside the treatises to be found in these three collections
there is one other which, according to Neuburger, contrib-
uted more than all the others combined to the fame of the
Medical School of Salerno. The title of this extraordinary
work is: *' Regimen sanitatis Salernitanum."

MEDICAL INSTRUCTION AT SALERNO 247

The Salernian writings, it appears, may readily be
divided into two groups — those of the earlier and those of
the later epoch of this famous school. The treatises which
belong to the older epoch are written in the degraded Latin
of the Middle Ages, and seem to have been composed
entirely for didactic purposes. In the main they are
compilations of still earlier Graeco-Latin works, but here
and there, especially in the parts which relate to thera-
peutics, evidences of a certain m'easure of originality are
discoverable. The pathology adopted shows a hodge-podge
of the humoral doctrine and that of the Methodists.

The chief representative of this early epoch is Gario-
pontus (first half of the eleventh century), whose treatise
on special pathology and therapeutics — entitled ^^Passion-
arius ' ' — was very popular for a long period of years. Next
in order comes Petroncellus, whose ^^Practica" calls for
no special comment. Of the works of Alphanus, John
Platearius (the elder) and Cophon (the elder), we possess
only fragments. Trotula, who lived about 1059 A. D. and
was believed to be the wife of John Platearius I., attained
greater celebrity than any of those just mentioned. She
was related to Eoger I., Count of Sicily, and was therefore
probably of Norman extraction, and she was considered by
her contemporaries to be very learned {^^ sapiens mat-
rona^^).^ Her writings, which are quite numerous, are
frequently quoted by later authors, this being especially true
of her work on diseases of women. The four other women
who took an active and creditable part in the work of the
Salerno Medical School also wrote treatises on various sub-
jects: Abella, on '* Black Bile" (written in verse) ; Mercu-
riade, on ** Pestilential Fever," and also on ''The Treatment
of Wounds"; and Rebecca Guarna, on ''Fevers." In the
case of Costanza Calenda, the daughter of the Dean of the
medical school and a woman remarkable for her wisdom
as well as for her great beauty, no record of the treatises
which she wrote appears to have been preserved.

The later epoch of the literature created by the Medical
School of Salerno begins about the year 1100 of the present

1 Perhaps the French title ' ' sage-f emrae ' ' originated from this.

248 GROWTH OF MEDICINE

era, after the Latin translations and compilations made by
Constantinus the African had taught the physicians who
were then at the head of affairs something about the
medicine of the Arabs, and had, at the same time, through
the latter medium, brought to their attention afresh the
teachings and practice of the ancient Greeks.^ Among the
works of the latter character — works which in their Latin
dress proved most valuable to the Salerno physicians — are
the following: "The Aphorisms of Hippocrates";
"Galen's Ars Parva^^ (Mikrotechne) ; and the same
author's "Commentaries on the Hippocratic Writings."

John Afflacius, a monk who lived during the latter half
of the eleventh century of the present era^ was one of the
pupils of Constantinus. His treatise "On Fevers,"
according to Neuburger, contains ample evidence of the
author's ability as a clinical observer.

Something still remains to be said concerning Bartholo-
maeus, Cophon the Younger, John Platearius the Younger
and Archimathaeus. They have already been mentioned
in the list of authors whose writings contributed materially
to the celebrity of the Medical School of Salerno, and it is
now only necessary to furnish a few particulars with
regard to their lives and the nature of the work which they
accomplished.

Bartholomaeus wrote a treatise (entitled "Prac^ica")
on the practice of medicine as taught by Hippocrates,
Galen, Constantinus and the Greek physicians. Its endur-
ing popularity is evidenced by the facts that it was trans-
lated at an early period into several languages and that
portions of its text are often quoted by later authors. The
book contains ample evidence that its author was a very

2 There can be no question, says Neuburger (in agreement with Daremberg),
about the truth of the statement that Constantinus allowed the authorship of
several of the treatises issued at Salerno under his name to be attributed to
himself — as, for example, the "Liber Pantegni" (Pantechni) , which is in
reality the "Liber Begalis" of Haly Abbas; the " Pieticum," which is funda-
mentally the work of fbn-al-Dschezzar; the "De Oculis," which is based upon
Honein ben Ischak's treatise on opthalmology; and still other works which
it is not necessary to specify.

MEDICAL INSTRUCTION AT SALERNO 249

close observer and a physician who strove to make accurate
diagnoses.

Cophon the Younger (about 1100 A. D.) was the author
of two. works : a treatise on anatomy which bore the title
^'Anatomia Porci," and one on the practice of medicine
{^^ Practical ^). The ancients, it is stated, selected a pig for
purposes of anatomical study ''because its internal organs
present a very close resemblance to those of the human
being." Both books are written in a clear and simple
style.

John Platearius the Younger was the author of a work
on internal medicine {^^Practica Brevis^^) and also of one
on the subject of urine {^^Regulae Urinarum^^).

Archimathaeus wrote and published three treatises : one
on ''Urines," another on practical medicine {^' Practical ^),
and the third on ' ' The Demeanor which a Physician should
Observe when he Visits a Sick Person" ("De Aventu
MedicV'). The latter treatise, says Neuburger, is "a
mixture of piety, artlessness, and slyness ; but it furnishes
a capital picture of the carefully regulated behavior of the
mediaeval physician at the patient 's bedside, of the manner
in which he conducted his examination of the case, and
of his intercourse with the household as well as with the
sick person."

In addition to the treatises referred to above, — treatises
which are known to have been written by the authors to
whom I have credited them, — the Collectio Salernitana
contains several of which the authorship is not known.
One of these, which bears the title "De Aegritudinum
Curatione," is reputed to furnish a better account of the
special pathology and therapeutics taught at the Medical
School of Salerno during the height of its celebrity than
is to be found in any of the other treatises. In one part
of the book — that, namely, in which local affections are
discussed — the anonymous author gives in succession the
opinions held by the seven leading teachers of the school
(Platearius II., Cophon II., Petronius, Afflacius, Bartholo-
maeus, Ferrarius and Trotula) with regard to each one of

250 GROWTH OF MEDICINE

a certain number of local diseases; thus enabling the
reader to obtain a very fair idea of what was the condition
of medical science at Salerno during the twelfth century
of the present era.

The famous didactic poem known as the ''School of
Salerno" {Schola Salernitana) and also as the ''Code of
Health of the School of Salerno" {Regimen Sanitatis
Salernitanum), was composed originally about 1100 A. D.
It was clearly intended in the first instance for the guidance
of laymen in matters relating to diet, the conservation of
health and the prevention of disease; but from time to
time, as the years rolled on, there were added to it several
sections which changed materially the character of the
poem. From a mere code of health it became eventually
a fairly complete cyclopaedia of medicine in versified
form; the number of the verses having increased fully
tenfold during this long period. The poem, in its latest
state, is arranged in ten principal sections, as follows:
Hygiene (8 chapters) ; materia medica (4 chapters) ;
anatomy (4 chapters) ; physiology (9 chapters) ; etiology
(3 chapters) ; significance of different signs (24 chapters) ;
pathology (8 chapters) ; therapeutics (22 chapters) ;
nosology (20 chapters) ; and the practice of medicine as
actually experienced (5 chapters).

The work has been translated into nearly every modern
language, and, according to an estimate which was made
in 1857, there are in existence no fewer than 240 different
editions. The most recent of these is the French trans-
lation made by Meaux Saint-Marc and published by him
(2d edition) in Paris in 1880. There are two English
versions — that by A. Croke (Oxford, 1830), and the more
recent one by John Ordronaux (Philadelphia, 1871).

Some authorities make the statement that the poem was
written originally for the guidance of Robert, the son of
William the Conqueror; but Neuburger says that the
dedication of the work to this prince is lacking in many
of the original manuscript copies and that in some instances
the word "Francorum" is to be found in the place of

MEDICAL INSTRUCTION AT SALERNO 251

''Anglorum"; for which reason he believes that the
introduction of a dedication was made long after the poem
had been written. It will probably appear strange to most
readers that the author of the ^^ Regimen Sanitatis^^ (or
^^Flos Medicinae/' as it was sometimes called) should have
written his text in the form of verse rather than in that
of prose. He himself states briefly, at the end of the poem,'
some of the reasons why he preferred to adopt this course.
Ehythm, he maintains, makes it easy to say a great deal in
a few words ; besides which, it facilitates by its novelty the
memorizing of new facts, and also enables one quickly to
recall to mind those which have been learned at some
previous time. His judgment seems to have been entirely
correct, for the book proved to be immensely popular, and
retained its popularity throughout an extraordinarily long
period of time. Furthermore, as already stated, it accom-
plished a great deal toward enhancing the reputation of
the Salerno School of Medicine. When we consider how
difficult it must have been in those days for students of
medicine to memorize facts which were stored in books that
were very costly and oftentimes not obtainable at any
price, we cease to wonder at the great popularity of this
miniature cyclopaedia in leonine verse.* Here were to be
found, at one-fourth or one-tenth the price of any similar
book written in prose, all the essentials (anatomy, physi-
ology, pathology, etc.) required by the candidate for
medical honors; and if, perchance, he possessed a good
memory, he might, without a very great mental effort,
transfer the entire poem to his own private storehouse
of facts.

A few extracts from this remarkable piece of medical
literature are given below, in the belief that many of our
readers will find them of interest.

3 Under the heading ' ' Epilogus ' ' on pages 268 and 269 of Meaux Saint-
Marc 's version.

* Examples of leonine versification : ' ' Contra vim mortis, nulla est herba in
Jiortis" ; (p. 155 of Saint-Marc's version) and (from Shelley's Cloud) "1 am
the daughter of the earth and water."

252

GROWTH OF MEDICINE

OEIGINAL TEXT
Si vis incolumen, si vis te vivere

sanum,
Curas toUe graves, irasei crede

profanum,
Parce mero, coenato parum ; non

sit tibi vanum
Surgere post epulas; sommini

fuge meridianum ;
Ne mictum retine, ne comprime

fortiter anum.
Haec bene si serves, tu longo

tempore vives.

Conditipnes Necessariae Medico.
Clemens accedat medicus cum

vesta polita ;
Luceat in digitis splendida

gemma suis.
Si fieri valeat, quadrupes sibi

sit pretiosus;
Ejus et omatus splendidus at-

que decens.
Ornatu nitido conabere carior

esse,
Splendidus ornatus plurima

dona dabit
Viliter induetus munus sibi vile

parabit.
Nam pauper medicus vilia dona

capit.

DE. JOHN OEDEONAUX'S

TEANSLATION

If thou to health, and vigor

wouldst attain.
Shun weighty cares — all anger

deem profane.
From heavy suppers and much

wine abstain.
Nor trivial count it, after pom-
pous fare.
To rise from table and to take

the air.
Shun idle, noonday slumber, nor

delay
The urgent calls of Nature to

obey.

Demeanor Necessary For the

Physician.
Let doctors call in clothing fine

arrayed,
With sparkling jewels on their

hands displayed;
And, if their means allow, let

there be had,
To ride, a showy, rich-attired

pad.
For when well dressed and look-
ing over-nice,
You may presume to charge a

higher price.
Since patients always pay those

doctors best.
Who make their calls in finest

clothing dressed,
While such as go about in simple

frieze.
Must put up with the meanest

grade of fees ;
For thus it is, poor doctors

everywhere
Get but the smallest pittance

for their share.

MEDICAL INSTRUCTION AT SALERNO 253

At Salerno the anatomical demonstration made, appar-
ently only once a year, for the benefit of the students,
consisted in exposing to view the abdominal viscera of the
pig and commenting upon the features which distinguish
them from the same organs in the human body. In the
^^ Regimen Sanitatis" only eight lines of text are devoted
to anatomy.

In section IV., which relates to physiology, the text is
more instructive and entertaining, but still — as compared
with the splendid work accomplished by Galen — extremely
incomplete and superficial.

In the early part of the twelfth century, Nicolaus
Praepositus^ composed, at the request of his colleagues in
the school of Salerno, an **Antidotarium" — that is, a
collection of formulae for combining together, in a single
pharmaceutical preparation, various drugs, both those
commonly employed in that part of Europe and others
which were then known only to the Arabian physicians.
This book of formulae, containing as it did descriptions
of the effects which might be expected from the different
preparations, and furnishing instructions with regard to
the proper mode of employing them, served its purpose
admirably, not only in Salerno but throughout Europe, at
least during the Middle Ages. All the pharmacopoeias of
a later date were based upon his ''Antidotarium," and
indirectly upon the still earlier celebrated treatises written
by Matthew Platearius and bearing the titles '^Glossae^^
and '^ Circa instans^^ (also that of '^De simplici medicina^^).
The most remarkable item, however, which is to be found
in the Antidotarium is that in which mention is made of
the use of soporific sponges {^'spongia soporifera'^), for
anaesthetizing purposes by means of inhalations, in certain
surgical procedures. (Neuburger.) They were made by
impregnating the sponges thoroughly with the juices of
narcotic plants (opium, hyoscyamus, mandragora, lactuca,
cicuta, etc.), drying them, and putting them aside until they
were actually needed. Then the sponge was saturated for

5 The term ' ' praepositus ' ' means the president or the dean of the school
with which the person named is connected.

254 GROWTH OF MEDICINE

about an hour with hot water or steamed, after which it
was applied over the patient's nostrils and held there until
the inhalation of the fumes had induced sleep.

Another Salernian treatise worth mentioning is that
written by Peter Musandinus, under the title *'0n Foods
and Beverages suitable for Persons affected with a Fever. ' '
This writer, who was one of the teachers at the school of
Salerno about the middle of the twelfth century, says that
great attention was paid in his time to the preparation of
foods in such a manner as to tempt the appetite of people
who were ill. He speaks of a meat extract which is pre-
pared from the flesh of the chicken, and also recommends
that a soup made by boiling a fowl in rose water be given
to patients who are affected with diarrhoea. He even goes
so far as to lay stress upon the importance of serving food
to a sick person in dishes which are pleasing to the eye.
Apropos of the subject of foods that are easily digestible
and therefore suitable for invalids I may mention how
Meaux Saint-Marc translates or interprets the line in the
''Regimen Sanitatis Salernitanum" which reads 0 fluvialis
anas, quanta dulcedine manas! His version may be ren-
dered into English thus :

* ' Oh wood-duck, how gently doth thy soft flesh glide over
the internal surface of the stomach!"

Toward the end of the twelfth century (1180 A. D.) there
was published at Salerno a work on surgery — the oldest
treatise on this subject that is known to have been written
in Italy during the Middle Ages. It is now called ' ' Roger 's
Practice of Surgery," but originally it was spoken of (in
accordance with a custom quite common in those days) as
^^Post mundi fahricam," which are the first three words
of the text. This book is of a very practical character and
is written in a simple, straightforward style. While it
contains the usual amount of traditional knowledge about
surgical matters, it gives at the same time the results of
the personal experience of Roger, of his teachers, and of
his associates. As published in the ^^Collectio Salernitana^*
the work represents, not the treatise as it was originally
written, but a revision made by Rolando of Parma. It is

MEDICAL INSTRUCTION AT SALERNO 255

divided into four parts or books, the topics treated in which
comprise most of those usually discussed in works on
surgery. Under the heading ** Wounds of the Intestine,"
in Book III., there occurs this most remarkable piece of
advice, viz., *'to insert into the intestinal canal a small
tubular piece of elder and then to stitch the raw edges of
the bowel together over it."

Another treatise on surgery, entitled ^^Chirurgia
Jamati/' was published at Salerno before the end of the
twelfth century. Its authorship is attributed to Jamerius,
and in many respects it resembles closely the treatise of
Roger.

The ^'Regimen Sanitatis^^ was not, it appears, the only
treatise on medicine which was published at that period
in the form of a poem. Gilles de Corbeil (Petrus Aegidius
Corboliensis), who had received his professional training
at the school of Salerno and was afterward appointed the
personal physician of King Philip Augustus in Paris
(1180-1223 A. D.), wrote versified treatises on these two
groups of topics — *'The pulse, the urine, and the beneficial
characteristics of composite remedies," and ''The signs
and symptoms of the different maladies." Both of these
treatises were received everywhere throughout Europe
with great favor and they maintained their popularity for
a period of over four centuries. A French translation (by
C. Vieillard) of the treatise on urology was published in
Paris in 1903. An edition of the '^De signis et symptoma-
tihus aegritudinum^^ was printed in Leipzig in 1907. The
following five lines are quoted by Neuburger; and they
certainly display the remarkable gift possessed by Aegidius
for condensing a large amount of information into a very
small space: —

DE CONDITIONIBUS URINAE

Quale, quid, aut quid in hoc, quantum, quotiens, uhi, quando,

Aetas, natura, sexus, labor, ira, diacta,

Cura, fames, motus, lavacrum, cibus, unctio, potus,

Debent artifici certa ratione notari.

Si eupit urinae judex consultus haberi.

256 GROWTH OF MEDICINE

To translate this into easily comprehensible English
prose would certainly require the employment of at least
five times as many words.

Another physician who received a part of his training
at Salerno and who is mentioned by Neuburger as *'The
greatest eye surgeon of the Middle Ages," is Benevenutus
Grapheus (twelfth century), a native of Jerusalem, and
probably of Jewish parentage. He wrote a practical
treatise {^'Practica oculorum^') which had a wide circula-
tion, and which has been translated into Provengal, French
and English.

Toward the end of the thirteenth century the famous Med-
ical School of Salerno began to show signs of decadence.
Various circumstances were responsible for this change.
In the first place, its career of great usefulness had already
covered a period of about seven hundred years, and —
according to the law affecting all things human — its time
of decrepitude was already more than due. Then, in the
next place, vigorous rivals were beginning to appear in
different parts of Europe, — at Bologna, at Montpellier and
at Paris, — and these new schools must have attracted large
numbers of students who otherwise would have frequented
the University of Salerno for the educational facilities
which they required. Commercialism — ^if such a term may
be employed to characterize the action of those who were
not willing to undergo the entire course of training
required for obtaining the full privileges belonging to a
physician — may perhaps also be named as one of the
influences which contributed to the slow breaking up of
the school. That this force had already begun to exert
some effect upon the management of the institution may
be inferred from the fact that in 1140 A. D., Roger, King
of Sicily and Naples, promulgated the law that nobody
would be permitted to practice medicine in his kingdom
until he should have satisfied the royal authorities that he
was properly qualified to undertake such practice. The
establishment of such a law surely indicated that the
number of those who were incompetent to assume the
responsibilities of a practitioner of medicine was alarm-

MEDICAL INSTRUCTION AT SALERNO 257

ingly on the increase; and, after it had gone into effect,
many must have been deterred from choosing a medical
career, and perhaps others have been diverted to schools
which were located in countries where the laws were more
lax. In 1240 A. D. the Eoman Emperor Frederic II., who
was also King of Sicily, made it a law that the course of
medical studies at Salerno should cover a period of five
years. All these factors taken together would seem to have
been sufficient slowly to diminish the popularity of this
celebrated school. But to these there were added, in the
latter half of the thirteenth century, — if we may believe
Puschmann, — two new factors, which exerted a powerful
influence in destroying all hope of further regeneration,
viz., the establishment of a university at Naples, in 1258
A. D., by Manfred, King of Sicily, and the narrow and
illiberal spirit in which the Church, by this time in almost
full control of the education at Salerno, managed the
medical school.

During the following four centuries the University of
Salerno — for during the thirteenth century it became a
university in fact, if not in name — retrograded steadily,
until finally the French Government, on November 29, 1811,
officially put an end to its existence. The traveler who
to-day visits Salerno, in the hope of seeing some remains
of the oldest medical school in Europe, will find there only
a collection of squalid buildings which serve as dwellings
for the poorer classes, a dirty and uncomfortable inn, and
shops of nearly the same dimensions as those which once
lined the narrow streets of Pompeii. As he gazes, how-
ever, at the superb view presented by the Gulf of Salerno
he may readily, by an effort of the imagination, reconstruct
the picture of the famous * * Hippocratic City" as it was
when William the Conqueror and other distinguished
persons visited it nearly a thousand years ago.

Neuburger, in his review of the career of the Salerno
Medical School, sums up its contributions to the science
of medicine in about these terms: Those who taught at
Salerno were the first physicians in the Christian part of
Western Europe who procured for medicine a home in

258 GROWTH OF MEDICINE

which scientific considerations alone prevailed, where the
Church exercised no control whatever, and where all the
different branches of the science were favored to an equal
degree. They devoted their best energies, by oral teaching
and by their writings, to the single object of communicating
practical knowledge of the healing art to all who desired
to obtain it; and, by the admirable example of their own
lives, they furnished a high standard for the guidance
of those who wished to reflect honor upon the name of
physician.

^

CHAPTER XXII

EARLY EVIDENCES OF THE INFLUENCE OF THE
RENAISSANCE UPON THE PROGRESS OF MEDI-
CINE IN WESTERN EUROPE

In previous chapters we have seen how the Arabs,
inspired with an extraordinary zeal for acquiring knowl-
edge of the different sciences, devoted time and money
freely, throughout a period of several centuries, to the
accomplishment of this purpose. They were fired with
ambition to become a great nation, and their studies of the
world's history taught them that the ancient Greeks had
accumulated in their literature vast stores of the very
knowledge which they were so anxious to acquire. Accord-
ingly all their energies were directed toward converting
these stores from the Greek into their own language, the
Arabic. This widespread eagerness of the nation, at a given
period of its history, to improve itself intellectually is
spoken of as the Arabic Renaissance, and, at the time which
I am now about to consider, the movement had practically
come to a standstill. A short time, however, before this
occurred, the physicians of Italy and of the more northerly
countries of Western Europe began to show a similar
desire to add to their medical literature; and their first
step, like that of the Arabs four or five centuries earlier,
was directed to the work of translating Arabic medical
treatises into debased Latin, which was the language
commonly employed by the learned during the Middle
Ages. The knowledge which they desired to acquire could
not at that time be obtained in any other way, for nobody
was acquainted with the Greek language, and, besides,
Greek originals had not yet been brought into Western

260 GROWTH OF MEDICINE

Europe. These first evidences of the Renaissance in that
part of the world were not confined to physicians; they
were to be found in every walk of life. The development
of the movement reminds one of what takes place near the
sea coast, where a period of heat and calm is suddenly
broken by the appearance of a few gentle puffs of wind,
which are quickly succeeded by the full force of a steady
and refreshing sea-breeze. In like manner feeble indica-
tions of the coming movement appeared in Italy, France,
Germany and even England, and these were soon followed
by unmistakable evidences that a genuine Renaissance of
widespread proportions had begun. It was as if a great
awakening had taken place among the nations which had
for centuries lain dormant; an awakening which was
followed by a desire to lay aside the trivial pursuits in
which they had so far been engaged, and to attain those
results which were, later on, to excite the wonder and
admiration of the world. Such were, for example, the
development of the art of printing ^4th movable types;
the discovery of America; the production of such clever
painters, sculptors, engravers, workers in metal, etc., as
Michael Angelo, Raphael, Albrecht Diirer, Benvenuto
Cellini, Rembrandt, and literally scores of others of nearly
equal merit; the development of a Shakespeare, a Milton
and a Dante in the field of literature ; the production of a
Luther, a man who had the courage to protest against evil
practices which had crept into the Christian church. And
medicine, as I have already stated, felt the influence of
the approaching Renaissance, and responded to it by
eJEforts which had for their object the acquisition of such
knowledge as might be furnished by translations from
Arabic treatises. Constantinus, the African, of whom
mention has been made on a previous page, seems to have
been the first person (toward the end of the eleventh cen-
tury) who did any work of this kind; but his associates in
Salerno do not appear to have valued these translations
very highly, or else, perhaps, they were not yet prepared
to give serious consideration to works which were new to
them. In the twelfth century, as will now be seen, the

INFLUENCE OF THE RENAISSANCE 261

attitude of the physicians of Western Europe underwent
a change.

The city of Toledo, in Spain, was richly stocked with
the manuscript treasures of Arabic literature at the time
(1085 A. D.) when it fell into the hands of the Christians.
One of the earliest scholars to engage in the work of trans-
lating these treasures into Latin was Gerard of Cremona,
in Lombardy, who lived during the twelfth century (1114-
1187 A. D.). He spent most of his lifetime in Toledo,
* learning and teaching, reading and translating." (Neu-
burger.) Among the medical works which he translated
from the Arabic the most important are the following:
Several of the writings of Hippocrates and Galen; the
Breviarium of Serapion ; several of the writings of Rhazes
and of Isaac Judaeus ; the treatise on surgery by Abulcasis ;
the Canon of Avicenna, etc. This stimulated many others
to follow in the footsteps of Gerard of Cremona ; and thus,
during the thirteenth century, a number of works of
importance were translated in addition to those already
mentioned. Such, for example, were the **Colliget" of
Averroes by Bonacosa, a Jew (1255) of Padua; the
^'Te'issir" of Avenzoar, and the ''Dietetics" of Maimonides
by John of Capua, a Jewish convert to Christianity (1262-
1278) ; the ''Z>e veribus cordis" of Avicenna by Arnaldus
of Villanova (about 1282); the treatise '^De simplicihus"
of Serapion the Younger, and the ^^ Liber servitoris^^ of
Abulcasis, by Simon Januensis; and many others. This
wave of keen interest in the writings of Arabic physicians
and in the Arabic versions of Greek medical authors soon
reached Languedoc in France, and then passed over from
there into Italy. For a long time the Salerno physicians
resisted its influence, but they finally yielded to it, as the
leaders in the schools of Bologna, Naples, Montpellier and
Paris had already done. It was at Palermo, in Sicily,
however, that the movement received its greatest impetus.
Frederick II., at that time King of Sicily, and a ruler who
was most tolerant in religious matters, had at his Court
an entire staff of Arabic physicians, philosophers, astrolo-
gers and poets; and, in addition, he kept a number of

262 GROWTH OF MEDICINE

learned Christians and Jews constantly busy translating
Arabic works into Latin. The most widely known member
of the latter group was Michael Scotus (or Scottus), who
at one time had been a teacher in the Medical School of
Salerno. Among the books which he translated while he
was at Palermo there were several of Aristotle 's treatises,
more particularly those which dealt with psychological
topics and with natural history. Frederick not only did
everything in his power to promote the work of trans-
lating, he also took pains to distribute copies of the Latin
versions, when completed, among the universities of
Western Europe. His son, Manfred, who succeeded him
on the throne, seems to have been almost as much interested
in the work as his father had been. It was from him, for
example, that the University of Paris received a set of the
Aristotle volumes in Latin. When Charles I., King of
Naples (1265-1285 A. D.), conquered Sicily he manifested
considerable interest in continuing the work of his prede-
cessors, particularly as regards treatises relating to medi-
cine. Among the translators whom he employed for this
work was Farragut (in Arabic, Faradsch ben Salem), from
Girgenti, a small town on the south coast of Sicily, about
sixty miles from Palermo. In addition to several treatises
of minor importance he translated into Latin the colossal
work of Rhazes — the ' ' Continens. " Charles I. kept at his
Court not only expert translators, but also skilled illumi-
nators ; and it was by them that the celebrated manuscript
copy of this work which is to-day in the Bibliotheque
Nationale at Paris, was illustrated with miniatures, three
of which are portraits of Farragut. This particular copy
of the *'Continens" was completed in 1282 A. D. Not a
few of the translations made during this period, it should
be stated, are now very difficult to understand. In the first,
place, the Latin in which they are written is of the barbaric
type (neo-Latin), something quite different from that
employed by Cicero, Tacitus and other Roman authors of
the classical period ; and, in the next, it is not infrequently
evident that the translator himself did not clearly appre-
hend the meaning of the original Arabic text. Despite all

INFLUENCE OF THE RENAISSANCE 263

these drawbacks, however, the placing of Latin versions
of Arabic writings within the reach of European physicians
accomplished much good. Even the imperfections to which
reference has just been made probably served to increase
the eagerness of these men to gain access to the real sources
of Arabic learning — ^viz., the writings in the original Greek.
To anticipate a little, I may say here that this object was
not attained until after the lapse of about two more cen-
turies— that is, not until the scholars of Western Europe
had learned to read the Greek, and had also brought out
from their hiding places in churches and monasteries of
the East the needed originals. At that period of the world's
history centuries corresponded to decades as modern
events are recorded.

One may gain some idea of the extent to which these
Latin translations of Arabic original treatises and of
Arabic versions of Greek medical works influenced the
physicians of Western Europe, by consulting one of the
important medical treatises of the fourteenth century —
that, for example, of Guy de Chauliac (written 1363 A. D.).
Edouard Nicaise, the accomplished editor of this and
several other mediaeval medical treatises, has printed in
his preface Joubert's table showing just how often Guy
quotes each one of about four score earlier authors, and
from this analysis it appears that Abulcasis was quoted
175 times, Aristotle 62 times, Avicenna 661 times, Galen
890 times, Haly Abbas 149 times, Mesne 61 times, Hip-
pocrates 120 times, and Ehazes 161 times ; or, to state the
facts somewhat differently, the quotations from treatises
introduced into Western Europe by the Arabs represent,
in the present instance, 70 per cent of all the quotations
(2279 of a total of 3243) made by this author. Another
equally strong piece of evidence is that afforded by Vincent
de Beauvais' encyclopaedia, — a work published in Paris
toward the middle of the thirteenth century, — in which the
parts relating to medicine appear to have been taken very
largely from treatises written by Arabic authors. (See
statement on page 270. ) There can therefore be no reason-
able doubt that the Arabs played a most important part

264 GROWTH OF MEDICINE

in the renaissance of medical learning which began a cen-
tury or two earlier, which already in the thirteenth century
had made great progress, and which very soon — as time is
reckoned in the calendar of all important world move-
ments— was to culminate in that still greater renaissance
called '* modern medicine."

During the later portion of the Middle Ages (thirteenth
and fourteenth centuries) there were four universities
which possessed medical schools of considerable impor-
tance— viz., those of Bologna and Padua in Italy, and those
of Montpellier and Paris in France. All of these seats of
learning, like the famous school at Salerno, developed so
gradually and from such modest beginnings that it is
scarcely possible to assign to any of them a date of origin.
Medicine was taught at several other places — as, for
instance, at Oxford, England; at Naples, Vicenza, Siena,
Rome, Florence, Ferrara, Pisa and Pavia, in Italy; at
Salamanca and Lerida, in Spain; at Prague, in Bohemia;
at Cologne, in Germany; at Vienna, in Austria, etc. But
the part which these smaller schools played in the work
of advancing our knowledge of medicine was certainly of
far less importance than that which fell to the lot of the
four institutions just mentioned.

The University of Montpellier, if not the oldest of the
four schools mentioned, was apparently the first to attain
some degree of celebrity. It is known, for example, that
the Archbishop of Lyons, who was suffering at the time
from some malady which the physicians of that city were
not able to cure, visited Montpellier 1153 A. D. in the belief
that he might there obtain the desired relief. John of
Salisbury, who lived during the latter half of the twelfth
century and who was considered one of the greatest
scholars of his time, declared that those who wished to
acquire a satisfactory knowledge of medicine, found that
Salerno and Montpellier were the only places where the
desired instruction might be obtained. Gilles de Corbeil
(mentioned in the last chapter). Von der Aue, and other
eminent men of the same period spoke in equally favorable
terms of the merits of Montpellier. The celebrated monk,

INFLUENCE OF THE RENAISSANCE 265

Caesarius of Heisterbach, calls the university of that city
''the headquarters of medical wisdom"; but at the same
time he expresses regret that the physicians of that school
not only do not believe in miraculous cures, but speak of
them ironically. It was one of the characteristics of the
institution that the teachers, both the medical and the
philosophical, were, at a very early period, allowed great
freedom of thought and speech; but, as time went on, this
liberty became very much curtailed. During the thirteenth
and fourteenth centuries there were, it appears, many Jews
among the students at Montpellier, not merely in the
department of medicine, but also in the other departments
of the university.

The medical schools of Salerno and Montpellier seemed,
at this early period (thirteenth century), to possess more
individuality than did the similar organizations at Bologna,
Padua and Paris ; for limited periods of time each of them
in turn enjoyed a certain amount of fame by reason of the
fact that some teacher or writer of special distinction
happened then to be officially connected with the school.
In other words, it was the fame of the man and not of the
school, that induced students to visit Bologna or Padua,
or Paris, during the thirteenth and fourteenth centuries.
At a somewhat later period (fifteenth and sixteenth cen-
turies) all three of these institutions stood out prominently
before the world as celebrated medical schools, with dis-
tinctive characteristics. To be invited to occupy a chair
in one of these institutions conferred honorable distinction
upon the incumbent selected, and when I reach that period,
farther on in this history, I shall describe each one of the
more important schools separately. In dealing with the
earlier epoch, however, it seems best to devote our attention
more particularly to individual physicians than to the
schools with which they may happen to be connected.

Among the physicians belonging to the latter half of the
thirteenth and the first quarter of the fourteenth century
there is one whose proper place in the history of medicine
is by no means easy to determine, and who yet played a
part of no small importance. This man was Pietro

266 GROWTH OF MEDICINE

d'Abano, or Petrus Aponensis, who was born at Abano, a
small village near Padua, 1250 A. D. Very little is known
about his early youth, but from this little we are warranted
in drawing the conclusion that his father, a notary, must
have taken great pains to afford him every possible educa-
tional advantage. He gave his son, for example, the
opportunity of studying Greek in Constantinople, — a thing
of rare occurrence in those early days, — and allowed him
to remain there until he had so far mastered the language
that he was able to translate the ^^Problemata" of Aris-
totle from the original text. Then, upon his return home
from Constantinople, he was sent to Paris for the purpose
of perfecting his knowledge of philosophy, mathematics
and medicine. After this thorough training for his life
work, Pietro d 'Abano began teaching philosophy in Padua,
and almost immediately he gained such success that people
spoke of him as **the great Lombard." However, like
most of the men of that time who became conspicuous
through their intellectual attainments, Pietro d 'Abano was
soon accused by the Dominicans of being a heretic and of
cultivating the magician's art. He was able to parry this
blow by making a journey to Rome and obtaining from
Pope Boniface VIII. a decree of absolution. About the
same time he began writing his two great works — the
^^Conciliator" and the ''Commentaries on Aristotle's
Problemata." He did not begin to teach medicine at the
University of Padua until 1306, when he was already fifty-
six years of age. But his lectures, reflecting as they did
the depth and extent of his learning and the keenness of
his powers of analysis, were a source of great astonishment
to his contemporaries. It is reported by Neuburger, for
example, that Gentile da Foligno, one of the most distin-
guished professors in the Medical School of Padua,
happening to pass near the auditorium while Pietro
d 'Abano was delivering his lecture, listened for a short
time and then exclaimed: ^^ Salve o santo tempio'^ — ''Hail
to this time which has brought forth such wonders ! ' ' With
the increase of Pietro 's fame came also a decided increase
in the bitterness of the persecution carried on against him

INFLUENCE OF THE RENAISSANCE 267

by his ecclesiastical foes, largely due perhaps to his open
and courageous defense of the Averroism which they so
much hated. There is very little doubt that he would have
been burned at the stake about this time if the friendly
disposition of the Popes and the mighty influence pos-
sessed by the city of Padua had not shielded him from this
danger. In 1314 the newly founded school of Treviso
invited Pietro d'Abano to occupy the Chair of Medicine
and Physics, and he accepted ; but he was taken ill and died
during the following year. Shortly before the occurrence
of this event he was placed on trial for heresy by the
Inquisition, and the proceedings were continued even after
his death. Indeed, according to one account of this famous
trial, not only was the charge sustained, but the prescribed
penalty was inflicted either upon the disinterred corpse
or upon an effigy of the condemned man. One century later,
the city of Padua erected a permanent memorial in Pietro
d'Abano's honor.

The principal work of this remarkable physician — viz.,
the ^^Conciliator differ entiarium philosophorum et prae-
cipue medicorum^^ — was first printed at Venice in 1471.
(It is said to be one of the earliest printed books known.)
It was a most popular treatise, as is shown by the fact that
between the year last mentioned and 1621 it passed through
a number of editions. Of the other treatises which he
wrote — some seven or eight in all — it will be sufficient to
mention here that one alone to which reference has already
been made in the preceding account, viz., the work entitled
'^Expositio prohlematum Aristotelis^^ (Mantua, 1475, and
Paris, 1520).

At this early period in the history of the Padua Medical
School there were one or two other men who attained a
considerable degree of celebrity for the excellence of the
work which they did, either as authors or as class-room
teachers. A brief account of one of these, Aegidius
Corboliensis, has already been given on a preceding page,
and it seems only fair that I should furnish here similar
brief accounts of some of the others — Gentile da Foligno,
Massilio and Galeazzo de St. Sophia, Giacomo and Giovanni

268 GROWTH OF MEDICINE

de' Dondi, and Giacomo della Torre, from Forli, all of
whom contributed greatly to the steadily increasing fame
of the Padua School of Medicine ; but, under the conditions
which govern the preparation of this brief history, I must
reluctantly pass over these names in silence.

CHAPTER XXIII

FURTHER PROGRESS OF MEDICINE AND SUR-
GERY IN WESTERN EUROPE DURING THE
THIRTEENTH, FOURTEENTH AND A PART OF
THE FIFTEENTH CENTURIES

Among the men who, during the thirteenth century,
exerted more or less influence upon the growth of medical
knowledge there are three who deserve to receive some
consideration at our hands. They were not physicians,
but yet some of their writings deal with topics which are
closely related to the science of medicine. They are:
Albert von BoUstadt, a German who is generally known
as Albertus Magnus, one of the greatest scholastic philoso-
phers of the Middle Ages ; Vincent of Beauvais ( Vincentius
Bellovacensis), a French Dominican monk, who was reader
to Louis IX., and who compiled a general encyclopaedia
which brought him great fame at that period; and Roger
Bacon, an Englishman who, by reason of the extraordinary
extent of his knowledge and his remarkable powers of
observation, was given the name of ** Doctor mirabilis."

Albertus Magnus. — ^Albertus Magnus was born at
Lauingen, Swabia, in 1193 A. D., obtained his education
in Italy (at the University of Padua, during the latter part
of his stay), joined the Order of the Dominicans on arriving
at the age of thirty, and afterwards, throughout his long
life, devoted himself largely to teaching, particularly at
Paris and Cologne. He was a prolific writer and his works,
particularly those which treat of topics belonging to the
domain of natural history, were greatly appreciated. The
eifect, however, which they produced upon a certain class
of readers was to persuade them that he was a great

270 GROWTH OF MEDICINE

magician. The chief distinction of his writings lies in the
fact that they contain a large number of original observa-
tions which he made during the course of his journeys
afoot through Germany in the character of Provincial of
the Dominican Order. This habit of exercising entire
independence in the use of his reasoning powers was some-
thing quite rare in those days. His observations were
directed chiefly to matters belonging to the domains of
zoology, botany, climatology, mineralogy, chemistry and
physics. The following significant advice, says Neuburger,
is attributed to him: **As regards the doctrines which
relate to questions of belief and of morality, it is the part
of wisdom to attach greater authority to Saint Augustine
than to the philosophers; in matters belonging to the
domain of medicine put your chief trust in Galen and in
Hippocrates ; in natural history, however, your best guide
is Aristotle." Neuburger adds that, throughout the writ-
ings of Albertus Magnus, there appear interesting state-
ments relating to anatomy, physiology, psychology, and the
plants and minerals which may be used for remedial
purposes.

An edition of the writings of Albertus Magnus (21 folio
volumes) was published in Lyons by Petrus Jamy in 1651.
The work was republished in Paris in 1892 and following
years.

Vincent of Beauvais. — Vincent of Beauvais, France, a
Dominican monk who lived during the first half of the thir-
teenth century and was the tutor of Louis the Ninth's
children, devoted the major part of his time to literary work.
He wrote many theological treatises and also edited a large
encyclopaedia in which information is furnished regarding
everything that was known at that time. Several hundred
authors aided him in compiling this work, which is entitled
^^ Speculum Ma jus/' It is arranged in three parts, one of
which {^^ Speculum Naturale^') consists of 33 books that are
divided into 3740 chapters; and quite a number of the
divisions are devoted to topics relating to medicine. The
authors, from whose writings this medical information has
been abstracted, are Hippocrates, Aristotle, Dioscorides,

FURTHER PROGRESS OF MEDICINE 271

Haly Abbas, Rbazes, Avicenna and several others — not to
mention the Church Fathers and other encyclopaedic writers
connected with the Church. The first printed edition of this
great work appeared toward the end of the fifteenth century
(1473-1475 A. D.) ; the last, or one of the last, in 1624. Lack
of space will not permit me to give any details concerning
the works of a somewhat similar character which were
prepared, about the same time, by the English Franciscan
monk Bartholomaeus of Glan villa (1260) ; by the Dominican,
Thomas of Cantimpre (1204-1280 A. D.), a pupil of Albertus
Magnus ; and by others.

Roger Bacon. — Roger Bacon was born about 1210 A. D.
in Ilchester, Somersetshire, England, and received his early
training at Oxford. When he was thirty years of age he
went to Paris and, after devoting himself assiduously for
seven years to the study of various branches of learning, he
received the Doctor's degree (1247). The wish to acquire
a thorough knowledge of whatever subject he undertook to
study constituted a prominent feature of his character. He
was fond of languages, but he had an even greater love for
mathematics, particularly in connection with astronomy, and
for experimental work in the department of chemistry. It
is said that he expended a large sum of money (£2000) upon
these chemical investigations. He left Paris in 1250,
returned to England, and not long afterward joined the
Order of the Franciscans. Robert Grossetete, Bishop of
Lincoln, and the Franciscan monk Adam of Marisco — two
men whom Neuburger describes as theologians of a very
liberal type — exercised a strong influence upon Bacon at
this period of his life. They confirmed him in the belief that
familiarity with the learned languages was an acquisition
greatly to be prized, and at the same time they gave him
every encouragement to pursue his researches in mathe-
matics and in natural history. For a certain length of time
he was an instructor at Oxford, but his views with regard
to ecclesiastic and moral questions and the discoveries which
he made in physics (especially in optics) were beyond the
comprehension of his contemporaries, who did not hesitate
to pronounce them works of the Devil and to subject Bacon

272 GROWTH OF MEDICINE

to all sorts of punishments and deprivations. Fortunately
for him and for the cause of science the newly elected Pope,
Clement IV. (1266), came to his rescue in those dark days
and granted him-— under the promise of absolute secrecy —
permission to continue his researches without hindrance and
to perfect the plans which he had in mind for reforms of
different kinds. I cannot follow this pioneer of scientific
research work, this man who was several centuries ahead
of the time in which he lived, through all the vicissitudes of
his interesting and extraordinarily fruitful life; I may
simply add that his death occurred about the year 1294;
that he left behind him many important treatises, only a
small portion of which have thus far been published,^ and
that from these alone one is justified in classing Roger
Bacon as one of the greatest thinkers whom history has
recorded. So far as is now known, he wrote very little
concerning medicine, and — strange to say — he seems to have
attached considerable importance to astrology; indeed, he
went so far as to blame the physicians of his day for their
ignorance regarding this science, ' ' as a result of which they
neglect the best part of medicine." In strange contrast
with these views, which to-day we characterize as foolish-
ness, is Bacon's famous dictum: *' Experiment is a firmer
and more trustworthy basis of knowledge than argument" —
a maxim which is the guiding principle of modern medicine.

The Medical School of Bologi^a. — The Medical School
of Bologna first began to assume a certain degree of promi-
nence in the early part of the thirteenth century, under the
teaching of Thaddeus Alderotti — also frequently called
Thaddeus of Florence.

Thaddeus Alderotti. — Thaddeus Alderotti, who was born
at Florence, Italy, 1223 A. D., of humble parentage, began
the study of philosophy and medicine at Bologna only after
he had reached manhood ; but he was such an earnest student
and made such good use of his opportunities that in 1260
he was chosen to serve as one of the teachers in the school.
Throughout a period of many years he filled the office so

iThe Opus majus, ed. J, H. Bridges, Oxford, 1897 (2d edition, 1900);
opera hactenus inedita, ed. B. Steele, Fasc. I., London.

FURTHER PROGRESS OF MEDICINE 273

acceptably that his colleagues bestowed upon him the name
of ''Master of Physicians." Before this time arrived,
however, his lack of funds was sorely felt, for he was
obliged, in order to support himself, to offer consecrated
wax candles for sale at the entrance of the church. He is
reported to have been not merely a most learned physician,
but also a very successful practitioner. He was called into
consultation from all parts of the country, so highly was
his opinion valued by other physicians ; and thus in due time
he accumulated a large fortune. His charges were by no
means small. It is related, for example, that Pope Hono-
rius IV. sent for him to come to Rome, and, after the treat-
ment was completed, paid him a fee of 10,000 gold pieces^ —
but not until after he had expressed surprise that Thaddeus
should have charged as much as 100 gold pieces per day for
his services. To this demurrer on the part of the Pope,
Thaddeus replied that the petty princes and even the simple
nobles made no objection to paying him 50 or more gold
pieces per day. It is scarcely necessary to add that the
Holy Father did not wish to be outdone by his inferiors.

Alderotti died 1303 A. D.

Among the writings of Thaddeus Alderotti which have
come down to our time there are to be found a number of
autobiographical references which are not without interest.
In one place, for example, he mentions the fact that he
occasionally walks in his sleep, and then proceeds (in Latin)
to discuss the phenomenon of sleep-walking as observed in
his own case. I give here a free translation of the text
printed in Neuburger 's History : —

The fourth question which suggests itself is this : Can the senses
during sleep come into active operation? Touching this fourth
question I reason thus: It appears as if, when one is asleep, the
senses must act, for a person may move about without incurring
any harm when he is in that state, as is often observed in the case
of those who, like myself, walk in their sleep Further-
more, it has been remarked that these people are able to harness
a horse and then to ride the animal safely, — acts which it is not

2 Aurei. The aureus is said to have been worth about 16 shillings, English
money.

274 GROWTH OF MEDICINE

possible to perform without the aid of the senses. On the other
hand, Aristotle maintains that a man, when asleep, is not capable
of using his senses. To this I reply by conceding that during
sleep a man certainly does not perceive what is going on about
him. "Wherefore, if you answer me by saying that the mere fact
of a man's ability to walk while he is asleep furnishes conclusive
evidence that he possesses his senses, I reply that movements like
that of walking are not the result of an impression made upon the
mind ("impressio imaginativa"), but the product of a different
mechanism, of a nature which permits it to operate during sleep.

As to the second point to which you call attention —

that, namely, with regard to the power of bridling and riding a
horse while one is asleep — I make this reply: These acts are per-
formed as a result of an impression made upon the mind through
the working of the imagination, and not as a direct consequence
of any images created upon the eye ; for, if the sleep-walker happens
to be in a strange house when the impulse to walk seizes him, he
will not go to the stable. The route which he is sure to take will
be one with which he is familiar, as happened in the case of the
blind teacher who, unaccompanied by any person, walked habit-
ually through the streets of Bologna. And then, besides, I am
able to speak from personal experience, for in one of my sleep
walks I jumped down from an elevation about four feet above the

ground without awaking from my sleep When, in the

course of one of these walks, I am exposed to cold, or when I hear
somebody speaking near me, I refer these phenomena entirely to
something within myself, and I return to my bed.

Of the four medical schools to which a brief reference
was made on a preceding page, that of Bologna was
probably the first to attain a certain degree of celebrity;
and it owed this distinction very largely to the work done
by men who were primarily surgeons, viz. : Hugo of Lucca ;
Theodoric, Hugo's son; William of Saliceto; and possibly,
to a very slight extent, Eoland of Parma, who spent only
a part of his professional life in Bologna. But there was
one other who, while he was not a surgeon, yet contributed
very greatly to the fame of the Bologna school and at the
same time to the real advance in surgical knowledge which
characterized the work of the men whose names have just
been mentioned — viz., Mondino. These men, especially

FURTHER PROGRESS OF MEDICINE 275

Mondino, cultivated the study of anatomy much more
earnestly than their rivals at Salerno had ever done, and
the surgical methods which they adopted were of a more
scientific character than those practiced by Roger. In the
treatment of wounds, for example, instead of striving to
bring about healing by the application of remedies which
stimulate suppuration, they favored the dry method; in
which practice they were justified not only by their own
experience but also by Galen's teaching: ''A dry state
of the wound approaches more nearly to what may be
considered the normal condition, whereas a moist state is
surely unhealthy." {Methodi medend., IV., 5.) As an
offset to the latter authority the Salerno surgeons quoted
that particular aphorism of Hippocrates (V., 67) which
reads: ^^Laxa bona, cruda vero mala.*' — almost the very
opposite of Galen's doctrine. Then again, the Bologna
surgeons effected improvements in other directions : They
materially restricted the use of the red-hot cautery iron,
and they cast aside as useless many of the complicated
apparatuses which had previously been employed in the
treatment of fractures and dislocations. It is evident from
these facts that the Bologna surgeons were not, as were
most of the physicians of the twelfth and thirteenth cen-
turies (Thaddeus of Florence perhaps excepted), slavish
followers of the ancients or even of the more modern Arabs,
but men who thought independently and who were not
afraid to use their own powers of observation.

Hugo of Lucca. — Hugo Borgognoni, more commonly
called Hugo of Lucca — was born in that city about the
middle of the twelfth century, served as municipal physi-
cian to the city of Bologna, accompanied the Bolognese
Crusaders on their expedition to Syria and Egypt, was
present at the siege af Damietta in 1219 A. D., and died a
short time before 1258, at the age of nearly one hundred.
He acquired a great reputation as a surgeon and brought
up several sons who followed in the same walk of life,
among the number being Theodoric, who gained even
greater celebrity than his father in the domain of surgery.
As Hugo himself left no writings of any kind, we are

276 GROWTH OF MEDICINE

largely dependent, for a knowledge of his achievements,
on the treatises which his son Theodoric wrote. From this
source we learn that Hugo recommended, for use in sur-
gical operations, the employment of narcotizing sponges
like those described on page 253, and was also an advocate
of the plan of treating wounds by the dry method (com-
presses soaked in wine over which simple dressings were
applied). In the treatment of empyema, of abscesses, of
penetrating wounds of the chest, and of both complicated
and simple wounds of the skull, he emphasized the wisdom
of adopting simple measures, of interfering with the parts
as little as possible, of abstaining from the use of the probe,
and of observing strict cleanliness. In cases of fracture
of a rib it was his practice to place the patient in a bath,
and then, with fingers which had been thoroughly oiled, to
attempt the replacement of the separated ends of the
fractured bone. Neuburger regards Hugo of Lucca as the
founder of the Bologna School of Surgery.

Theodoric of Lucca, known also as Bishop Theodoric,
was born 1206 A. D. While still quite a young man he
joined the recently established order of preachers, and not
long afterward was appointed Almoner {PoenitentiariusY
to Pope Innocent IV. Eventually he became Bishop of
Cervia, near Eavenna. By special permission of the Pope,
he was able to complete the surgical training which he had
received from his father, Hugo of Lucca; and thus, while
he still held the office of Bishop, he practiced surgery to
some extent in Bologna. In course of time his practice
became very extensive and also very lucrative ; as a result
of which he was able to leave a large fortune to various
charitable institutions. The first printed edition of his
work on surgery appeared in Venice in 1498, and was
followed by numerous later issues.

Theodoric, says Neuburger, was a most uncompromising
advocate of the dry method of treating wounds. His
( Theodoric 's) words are these: *'For it is not necessary —
as Eoger and Roland have said, as most of their disciples

3 A church official to whom was intrusted the duty of granting dispensa-
tions; "Almoner" is perhaps the equivalent term in English.

FURTHER PROGRESS OF MEDICINE 277

teach, and as almost all modern surgeons practice — to favor
the generation of pus in wounds. This doctrine is a very-
great error. To follow such teaching is simply to put an
obstacle in the way of nature's efforts, to prolong the
diseased action, and to prohibit the agglutination and final
consolidation of the wound."*

In his enumeration of the different means that may be
employed for arresting hemorrhage, Theodoric mentions
cauterization, tamponading, the application of a ligature,
and the complete division of the injured blood-vessel. He
attached great importance to the proper feeding of the
patient. In Book III., chapter 49, of his treatise on sur-
gery, he gives minute instructions with regard to the proper
manner of employing a salve made with quicksilver, and
at the same time he mentions the fact that he observed a
flow of saliva as one of the results of its use.

The expressions ''healing by first intention" and ** heal-
ing by second intention" are encountered for the first time
in the writings of Brunus, a surgeon who practiced in the
cities of Verona and Padua about the middle of the thir-
teenth century, and who was a vigorous advocate of the
dry method of treating wounds. His two treatises
{^^Chirurgia magna" and ^'Chirurgia minor ^*) were
printed in Venice in 1546. Neuburger says that although
a large part of the text in these volumes consists of
extracts from Galen, Avicenna, Hippocrates, Abulcasis
and other authorities, there are to be found at the same
time not a few observations of an original character.

William of Saliceto. — William of Saliceto {Guglielmo da
Saliceto) is accorded by Neuburger the honor of being
Bologna's greatest surgeon — ^if not, indeed, the greatest
surgeon of that period. He was born in the early part of
the thirteenth century and spent a large portion of his
professional life in Bologna, where he not only practiced

4 * ' Non enim est necesse saniem — sicut Rogerius et Rolandus scripserunt
et plerique eorum discipuli docent, et fere omnes cururgici modemi servant —
in vulneribus generare. Iste enim error est major quam potest esse. Non
est enim aliud, nisi impedire naturam, prolongare morbum, prohibere con-
glutinationem et consolidationem vulneris." (IT., cap. 27.)

278 GROWTH OF MEDICINE

medicine but also acted in the capacity of a teacher of this
science. During the latter part of his career he lived in
Verona, where he held the position of Municipal Physician
and Attending Physician of the City Hospital. He died
about the year 1280.

Saliceto's work on surgery is of a thoroughly practical
character and reveals the author to have been a born sur-
geon.^ In addition to the ^^Cyrurgia," which was first
printed in Piacenza 1476 A. D., he wrote a treatise which
bears the title ^^Summa conservationis et curationis"
(printed first in Piacenza in 1475). The ''Surgery" is
divided into five books, preceded by a short chapter on
general methods, etc. Book I. is devoted to affections of
the cranium, eruptions on the head, eye diseases, ear dis-
eases (snaring of ear polypi), nasal polypi, abscesses in
the axilla, affections of the mammary gland, tumors in
different parts of the body, venereal lesions in the groin,
and a long list of other surgical maladies. Book II.
describes wounds of all sorts, including those produced by
arrows (with reports of cases), penetrating wounds of the
chest and abdomen (with instructions about sewing both
longitudinal and transverse wounds of the intestine), etc.
Under the head of penetrating wounds of nerves (declared
by the author to be very dangerous), Saliceto recommends
enlargement of the wound, the application of oil, and the
employment of opium or hyoscyamus to quiet the pain.
Book III. treats the subject of fractures and dislocations
in a most thorough manner. Mention is made of the
crepitation noise heard in fractures {sonitus ossis fracti)
and a warning is given not to apply the bandages too tightly
and to be careful to change the dressings every three or
four days. The instructions given with regard to the
reduction of dislocations are said by Neuburger to be most
sensible. Book IV. contains such anatomical descriptions
as may be helpful to the practical surgeon. From these,
however, it is evident that the writer had never dissected
the human cadaver. Book V. is devoted to the subject of

6 The most recent edition of this work is a French translation made by
P. Pifteau and published at Toulouse, in 3898,

FURTHER PROGRESS OF MEDICINE 279

cauterizing and to the consideration of those remedial
agents which are commonly employed in surgery. The
instruments used for cauterizing purposes were made of
different metals, gold or silver being preferred for the
more delicate ones, and brass and iron for the others.
Immediately after the cauterization it was customary to
apply butter, or the fat of some animal, or oil scented with
roses, to the burned part.

Saliceto's other treatise — the Summa conservationis
etc. — is also divided into five books, which contain chapters
devoted to all the more important branches of internal
medicine and to questions of diet, of the physician's
behavior in the presence of a patient, etc. Especially
interesting are his remarks about the importance of con-
sidering the psychological effect produced upon the patient
by such matters as the physician's manner of feeling the
pulse, his carefulness to inquire about the patient's various
symptoms (how the night was passed, what food and drink
had been taken, etc.) — an effect which oftentimes is
*' greater than that produced by instruments and medi-
cines." In discussing the subject of prognosis, Saliceto
makes the remark that it is always proper for the physician
to hold out to the patient hope of recovery, although he
urges at the same time the wisdom of telling the whole
truth to the friends of the patient. He also lays great
stress upon the importance of **not holding any conversa-
tion with the lady of the house upon confidential matters."
Neuburger gives a number of other extracts from this most
interesting work; but I must abstain from devoting any
more space to this one mediaeval author, whose manner
of writing makes it difficult to realize that the treatise which
he has written belongs to the thirteenth century and not
to a very recent period.

Roland of Parma. — Roland, who was born in the city of
Parma and who spent a part of his life in Bologna, not
only edited the work of his teacher, Roger of Salerno, but
also wrote a concise treatise on surgery that is entitled

Rolandina.^' Neuburger speaks of this book as differing

II

280 GROWTH OF MEDICINE

but little from Eoger's ^^Practica chirurgiae.^^^ "It con-
tains, however, the report of a case of penetrating wound
of the chest in which Roland showed not a little courage
by daring to cut off, flush with the skin, a portion of lung
tissue which happened to protrude from the wound, and
then applying a simple dressing."

The treatise known by the title ^^Glossulae quatuor
magistrorum super chirurgiam Rogerii et Rolandi" was
written by an unknown author or perhaps by several
authors. It represents a collection of commentaries on the
works of the two who are mentioned in the title of the book,
and should probably be classed as a part of the literature
of the Salerno School of Medicine.

Mondino the Anatomist. — Mondino, who was the first
physician, after an interval of about fifteen hundred years,
to revive the practice of dissecting human bodies, was born
at Bologna at about 1275 A. D. He received his profes-
sional training at the medical school of his native city and
was given the degree of Doctor in 1290, at the age of
fifteen ( !). Not long afterward he began to teach anatomy
in the same institution and continued to serve in this
capacity up to the time of his death in 1326. The physicians
who aided him in his anatomical researches were Ottone
Agenio Lustrulano, his prosector, and a woman named
Alessandra Gilliani, from Perriceto.

Mondino 's method of teaching anatomy was to deliver
his lectures with the dissected cadaver directly before him ;
that is, he demonstrated the correctness of his statements
as fast as he made them. (See Fig. 9.) Such a method
was entirely new at the time and proved immensely popu-
lar, attracting students to Bologna in large numbers.
Partly in this way and partly by means of the treatise on
anatomy which he wrote {^^Anatomia MundinV^), he
became the instructor of numerous generations of physi-
cians. His treatise remained the authoritative guide in
anatomy up to the middle of the sixteenth century.

6 According to Daremberg (Histoire des Sciences Medicales, Vol. I., p. 264)
the title ' ' Doctor ' ' appears for the first time in the Preface of Eoger 's treatise
(1180 A. D.).

c

J.S6-

FIG. 9. THE OLDEST KNOWN PICTORIAL REPRESENTATION
OF A FORMAL DISSECTION OF THE HUMAN BODY.

The original, which is in the library of the University of Montpellier,
France, appears in a manuscript copy of Guy de Chauliac's Chirurgia magna
(fourteenth century). Eugen Hollander of Berlin, the author of Die Medi-
zin in der klassischen Malerei, has courteously given permission to copy the
reproduction. The many defects which appear in this picture are due to the
fact that the reproduction was taken directly from the original miniature,
now six hundred years old. Hollander gives the following description of
this interesting scene:

"In one of the rooms of the hospital a woman's dead body is lying
upon a table. Alongside the bed in which she died a nun is praying
for her soul. Two physicians are busily engaged in the work of dis-
secting the body. ^An instructor is reading out of a book, for the
benefit of the students who are crowding into the room, such por-
tions of the text as apply to the case in hand, and at the same time
he is directing their attention to the uterus which one of the dissect-
ors is Hfting out of the abdominal cavity. Owing to the defective
state of the original miniature it is not possible to state positively
what part the three women who stand near the head of the corpse
are taking in the scene, but it is not unlikely that they too are physi-
cians, especially as their presence on such an occasion would be quite
in harmony with the customs of that period of time."

FURTHER PROGRESS OF MEDICINE 281

In one place in his ** Anatomy," Mondino states explicitly
that he dissected two human cadavers in the month of.
January, 1315. This statement renders it possible to fix
the exact date when the practice of making such dissec-
tions— which had been carried on for a considerable period
of time about 250 B. C. — was first resumed. If one reflects
upon the nature of the obstacles which in 1315 stood in the
way of a revival of this practice, — for example, the deep-
seated prejudice against it entertained by all classes of
the community, and the very strong opposition of the
ecclesiastic authorities to what they honestly believed to
be a desecration of the human body, — one will readily
appreciate how great was the courage displayed by Mon-
dino when he almost openly undertook his first dissection.
The subsequent career of this famous teacher of anatomy
justifies the belief that his determination to take the course
which he did was based upon the profound conviction that
the first step toward increasing the scanty stock of knowl-
edge possessed at that time with regard to the structure
of the human body in all its parts, must necessarily be one
in continuation of that which Erasistratus and his asso-
ciates had taken centuries earlier, but which had not been
succeeded by a sufficient number of other steps in the same
direction. The series of discoveries in anatomy, physi-
ology and pathology which resulted from Mondino 's
courageous and intelligent act, form a part of the history
of modern medicine, and do not therefore call for consid-
eration in this place. We may simply add that much
information of a very interesting character is furnished
by Neuburger {op. cit.) with regard to the manner in which
Mondino and his immediate successors carried on their
instruction in anatomy from that time forward.

The Medical School at Bologna, as may well be imagined,
gained great fame from the possession of such distinguished
teachers as those whose careers I have briefly sketched —
Hugo and Theodoric of Lucca, William of Saliceto, and
Mondino; and it retained a large part of this celebrity
throughout the fourteenth and fifteenth centuries, despite
the appearance on the scene, toward the end of this time,

282 GROWTH OF MEDICINE

of several formidable claimants for high honors in the
domain of medical research and education — viz., the schools
at Montpellier and Paris, in France, and that of Padua, in
Italy.

Lanfranchi and the Medical School of Paris. — According
to Edouard Mcaise^ medicine was not taught publicly at
Paris previously to 1160 A. D. The teaching was carried
on at that time by associations of physicians, and it was
only during the following century (about 1250 A. D.) that
something like a university was established in that city.
Up to the end of the sixteenth century (1595 A. D.), during
the reign of Henry IV., this institution remained under
the control of the Church. Its functions — so far at least
as medicine was concerned — were limited to the bestowing
of degrees, for it possessed at that time no organization
of instructors and no permanent quarters in which the
teaching might be carried on systematically; a church
(see Fig. 10) or the Dean's residence serving as the locality
in which the lectures were commonly delivered.

During the middle part of the thirteenth century and for
a long time afterward, the practice of surgery, which was
then of a rather primitive type, was entirely in the hands
of two classes of men — the barbers and the so-called
surgeons.* As time went on, the surgeons began to feel
the necessity of securing better protection for their material
interests, which were being more and more encroached
upon by the barbers — a class of men who were not privi-
leged by the authorities to include in their field of acti^dties
anything beyond hair-cutting, shaving, cupping, the extrac-
tion of teeth, the application of leeches, the incision of boils
and perhaps one or two other simple operations. For this
reason, therefore, and also probably because they too felt

T^'La Grande Chirurgie de Chiy de Chauliac," Paris, 1890.

8 The distinguishing sign of the barbers was the shaving dish, made of
pewter and hung up at the door of the shop; that employed by the surgeons
was also a shaving dish, but made of polished brass. Those surgeons who had
received their training at the school of Saint Cosmas and Saint Damian were
permitted to display at the window a banner bearing the coat of arms of this
institution.

FURTHER PROGRESS OF MEDICINE 283

in some measure the effects of the Renaissance spirit which
was then abroad in the land, they organized themselves
(1254 A. D.) into an association which bore the name of
''College of Saint Cosmas" {College de St. Come).^ One
of the early acts of this association was to establish the
rule that all applicants for membership should pass suc-
cessfully an examination as to their fitness before they
could be admitted. Very little is known about the doings

FIG. 10. THE MANNER OP GIVING PUBLIC INSTRUCTION
IN MEDICINE DURING THE MIDDLE AGES.

(From Meaux Saint-Marc's L'Aco/e de Salerne.)
The present cut is evidently a modern copy of a much earlier original.

of the organization during the early years of its existence.
Later, as we shall see, it played a very important part in
the history of medicine in France.

» The surgeons Cosmas and Damian were chosen patron saints of the new
organization. They were born in Arabia in the third century, and are said
to have been educated there. After having practiced medicine for a certain
length of time in Sicily, they were tortured and killed, because of their Chris-
tian faith, by order of the Emperor Diocletian, 303 A, D. Hence the title
"Saints."

284 GROWTH OF MEDICINE

From the account given by Nicaise it appears that no
regular instruction in anatomy was given in the University
of Paris until after the fourteenth century, and then only
from three to five times a year, when the body of a person
who had been hung was publicly dissected. ''Such a
dissection lasted seven days and was a veritable scientific
festival." No official cliniques were held and the only
way in which the student of medicine could obtain some
practical acquaintance with disease and with the methods
of treatment was by attaching himself to a physician or a
surgeon, or to a barber.

From the preceding brief and very incomplete account
the reader will, I trust, be able to form some idea of the
condition of affairs, medical and surgical, in Paris at the
time when Lanfranchi arrived in that city.

Lanfranchi, says Neuburger, was born in Milan, Italy,
and was undoubtedly the most distinguished among the
pupils of Saliceto at Bologna. After leaving the medical
school he practiced both medicine and surgery for a certain
length of time in his native city; but finally, becoming
involved in the quarrels between the Guelphs and the
Ghibellines, he — ^like many other Italian physicians — ^was
obliged to take refuge in France. In Lyons, which was his
first place of residence, he engaged for a short time in the
practice of medicine and also wrote his first treatise on
surgery — ' ' Chirurgia Parva. ' ' Then, after traveling from
one place to another in the provinces, he finally (1295 A. D.)
settled permanently in Paris. In that city he very soon
acquired a large practice, and, at the same time, built up
for himself a great reputation as a teacher of medicine.
The College de St. Come elected him a member of that
organization and profited greatly from the fame which his
teaching brought to the institution. It is said that Jean
Passavant, who was at that time the Dean of the Medical
Faculty of Paris, aided Lanfranchi in his work by every
means in his power. As a result Paris, during a consider-
able period of time, was one of the few places in which
genuine clinical instruction was given to all those who
desired to acquire a practical acquaintance with disease.

FURTHER PROGRESS OF MEDICINE 285

His larger treatise, the * * Chirurgia Magna, ' ' was completed
in 1296. It was dedicated to the Eang of France, Philip IV.,
commonly called ^^Phillippe le Bel/' and its intrinsic merits
assured him a permanent reputation as a surgeon. This
work, which was translated years ago into English and has
recently (1894) been published by the ''Early English Text
Society," under the title *'Lanf rank's Science of Cirurgie,"
consists of five separate fasciculi or parts. A few extracts
from the text of this celebrated work may prove of interest
to the reader. Not having access to the English version
just mentioned, I shall have to translate from the version
(partly Latin and partly German) supplied by Neuburger.
Part I. of the Chirurgia Parva mentions some of the
characteristics which a surgeon should possess. He should,
for example, have well-formed hands, with fingers that are
long and slender ; his body should be strong and firm in its
movements; his hands and fingers should respond quickly
to the workings of the mind ; his mind should be of a subtle
type; in character he should not be over-bold, but self-
reliant and yet modest; he should have a good supply of
common sense; he should be well-informed not only in
medicine, but also in all the branches of philosophy; he
should be a good logician; he should be familiar with the
writings of medical authors; he should be virtuous and
ethical; he should be trustworthy; he should not be

avaricious nor envious; and, finally, he should be

thoroughly familiar with all the diseases to which the
human body is liable. In one place Lanfranchi refers to
the fact that exposure to the air favors the production of
pus in a wound. Among the methods which may be
employed for arresting hemorrhage he mentions digital
compression and ligaturing of the bleeding vessels. He
recommends that a wounded individual should abstain from
wine and from an over-nutritious diet. No attempt, he says,
should be made to extirpate, with the knife or by means
of the actual cautery, an ulcerated cancer, unless it appears
probable that by such means complete destruction of the
tumor may be effected. In traumatic tetanus dependent

286 GROWTH OF MEDICINE

upon an injury of a tendon or nerve trunk he recommends
complete division of the wounded structure.

Part II. is devoted to the consideration of wounds of the
different parts of the body, taken in regular order from
the head to the feet. The descriptions, in each instance,
are preceded by an adequate account of the region affected.
In his discussion of fractures of the skull he speaks of the
diagnostic value of the rough and jarring sound perceived
by the patient when the physician taps with a rod upon the
injured skull; and he also states that an aid to diagnosis
may be derived from the fact that a person whose skull is
fractured experiences pain at the seat of the injury when
somebody passes the ends of his finger-nails along a string
which the patient holds suspended between his teeth.^"
According to Neuburger the description which Lanfranchi
gives of the various symptoms observed in cases of fracture
of the skull is admirable. In the section relating to the
treatment of such fractures he warns against the tendency
to resort too readily to the use of the trephine, and
expresses the belief that this instrument should be employed
only when the fractured bone is depressed or when there
is evidence of irritation of the dura mater.

Part III. deals with skin diseases and various forms of
tumors, including those of the thyroid gland; and with
diseases of the eye, the ear and the nasal cavities; with
the various kinds of hernia; with renal and cystic calculi;
with hemorrhoids, varicose veins, etc.; with abdominal
dropsy; and with still other affections. In bloodletting he
recommends the practice of opening the vein longitudi-
nally. He is very emphatic in his manner of insisting that
medicine and surgery should not be divorced, and that the
operation of drawing blood should not be intrusted to
barbers.

After the death or retirement of Lanfranchi during the
first decade of the fourteenth century, Paris appears to
have played, at least for a few years, a comparatively small
part in the history of medical teaching. Her rivals at

10 Guy de Chauliac, who wrote a treatise on surgery in the latter half of
the fourteenth century, also speaks of the value of this diagnostic sign.

FURTHER PROGRESS OF MEDICINE 287

Montpellier, in the south of France, and at Bologna and
Padua, in Italy, far outstripped her during this period.
There was one physician at Paris, however, — Henri de
Mondeville, — who would probably have proved a worthy
successor of Lanfranchi if circumstances had not seriously
interfered with his acting the part of a teacher.

Henri de Mondeville. — Henri de Mondeville, says
Edouard Nicaise, was born about 1260 A. D. in Normandy.
In his native village — Mondeville or Mandeville, or Amon-
daville, all of which names are found in the manuscripts —
he was known simply as Henri, but in the outside world
and in medical literature he is mentioned, in accordance
with the prevailing custom of that period, as Henri de
Mondeville. After studying medicine for a certain length
of time in Paris and Montpellier, he went to Italy and
became the pupil of Theodoric of Bologna. He is said to
have been passionately fond of surgery, which at that
period was, in France, a much despised branch of medicine.
In Italy, on the contrary, such men as William of Saliceto,
Hugo of Lucca, Theodoric and Lanfranchi had raised sur-
gery to a position of great honor, and Henri de Mondeville
cherished the hope that he also might be able to accomplish
the same result in France, Upon his return to Paris he
was chosen one of the physicians (there were four in all)
of the royal household, and from that time onward he was
frequently obliged to set aside, for longer or shorter
periods, all his personal interests (private practice, lec-
turing to medical students, hospital service at Hotel-Dieu,
etc.) in order to attend the King or the Comte de Valois on
some military expedition. This sort of service, however,
was by no means time lost, for it afforded him the oppor-
tunity to acquire great experience in the treatment of
wounds, an experience which reveals itself on almost every
page of his treatise on surgery. And yet there came a time
(1312) when de Mondeville complained bitterly of these
interruptions, for which he received no pay and which
interfered seriously with his literary work. Despite these
hindrances, he appears to have made a fair degree of
progress in the writing of his book, for at the date last

288 GROWTH OF MEDICINE

named lie gave a public reading of the first two sections
** before a large and noble assemblage of medical students
and other distinguished personages." The portrait of
de Mondeville which is here reproduced is a copy of the
miniature which appears in one of the manuscripts of his
treatise that was prepared 1314 A. D., and is now preserved
in the Bibliotheque Nationale at Paris. Nicaise furnishes
the following details regarding the original miniature.

Inasmuch as the MS. bears the date 1314 the portrait must have
been painted while De Mondeville was still living. The master is
represented wearing a violet-colored gown, red stockings, and a
black skull-cap. He is thin, his beard is scanty and of a grey
color like the hair of his head, his features are finely cut, and he
appears to be a fairly tall man. So far as one may judge from
this portrait De Mondeville 's age was then about fifty.

The date of his death is not known exactly, but it must
have been somewhere about 1320 A. D.

Nicaise sums up de Mondeville 's personal history and
his contributions to the science of medicine somewhat as
follows : He was a man of warm impulses, who loved the
truth and despised all shams. He never hesitated to speak
his opinion about others, the King himself not being
excluded from his criticisms. He wa& also quite frank in
his exposures of the ignorance of both nobles and members
of the clergy. He was not in the least degree superstitious.
He remained unmarried throughout life and seems to have
entertained a slight disposition to find fault with women,
for he attacks somewhat violently their mode of life and
their extravagance, especially in the case of the women of
Montpellier. Although he possessed a great reputation
and a very large clientele of patients, he did not acquire
a fortune. He is quoted as saying: **I was obliged from
the very first to work hard for a living." Suppuration,
according to the view of de Mondeville, was not a necessary
phenomenon in the healing of wounds.

About the year 1316 the condition of de Mondeville 's
health — he probably had pulmonary tuberculosis — ^began
to give him serious cause for anxiety lest he might not live

FIG. 11. HENRI DE MONDEVILLE.

(From Nicaise's Version, Paris, 1893.)

From a miniature at the head of a manuscript which bears the date
A. D. 1313, now preserved in the Bibliothfeque Nationale at Paris.

FURTHER PROGRESS OF MEDICINE 289

long enough to complete his book ; and, as a matter of fact,
the treatise which we now possess shows that his fears
proved to be well grounded. The important subjects of
fractures, dislocations and hernia, for example, are men-
tioned only casually. Those subjects, however, which he
did discuss are treated in a very clear and practical manner.
Thus, for example, his instructions with regard to the
proper manner of treating wounds is most satisfactory.
Theodoric and he were the great champions of the so-called
dry treatment, which had been introduced at some remote
period of antiquity, but which apparently had not met with
general acceptance. Then, again, in his remarks on the
subject of amputations, he taught that the ligaturing of
the severed arteries after the removal of the amputated
part, was universally recognized as the proper course to
adopt and should never be neglected.

In Chapter VII. of the first section of his treatise, de
Mondeville gives a description of the anatomy of the heart
and related blood-vessels, and at the same time furnishes
an unusually clear account of the physiology of the circu-
lation which was universally accepted by the physicians
of that period, as it had already been by those of earlier
centuries. It seems desirable to reproduce this account
here in order that it may serve for purposes of comparison
with that which Harvey was to give three centuries later.
It is only by making such a comparison that the physicians
of our time can appreciate the vast importance which
attaches to Harvey's wonderful discovery. De Monde-
ville's account, abbreviated wherever it seemed practicable
to do this, reads as follows : —

The heart is the most important of all the organs. It transmits
to the other members of the body vitalizing blood, heat and spirit.
Its muscular tissue, unlike ordinary muscle, is composed of three
kinds of fibres, and it is not under the control of the will. It has
the shape of a pineapple and is located in the centre of the chest,
like a prince in the middle of his kingdom. Its lower extremity
is directed somewhat to the left of the chest, as we are assured by
the Philosopher (Aristotle) in his history of animals. There are
two reasons why it points toward the left : 1., in order that it may

290 GROWTH OF MEDICINE

not press upon the liver or be pressed upon by it ; and 2., in order
that it may not communicate its heat to the left side (the cool side)
of that organ.

It is important to note the fact that the heart is the only structure
which contains blood in its substance ; in all the other members of
the body the blood is contained in the veins. The base of the heart
is situated at its highest point and represents the broadest portion
of the organ ; it is attached to the posterior wall of the chest by a
few ligaments, than which no stronger are to be found in any part
of the body. These bands do not touch the heart at any point
except at the top, where they take their origin; and their great
strength is explained by the fact that it is their duty to hold the
heart firmly in its proper position.

The heart possesses two ventricles or cavities, of which the left
one — by reason of the natural position of the organ as a whole —
is a little higher than the right. Between these two cavities there
is placed a partition which in its turn contains a small cavity —
termed by some the third ventricle. Above each of the larger
ventricles there is a sort of appendix — cartilaginous in structure,
but flexible and at the same time strong, — which contains a cavity
and has some resemblance to a cat's ear. These structures, to
which the common people have given the name auricles, alternately
contract and dilate. The purpose for which they exist is to serve
as reservoirs for the blood and air that are needed for the nourish
ment and cooling of the heart.

To the right ventricle there comes a many-branched vein which
conducts to the heart a coarse, thick and warm blood destined to
nourish that organ. The portion of this abundant fluid which is
not needed for this purpose is then rendered less coarse and thick
by some subtle power possessed by the heart itself, after which it
is driven into the cavity that is located within the partition wall
which separates the ventricles the one from the other. From this
smaller cavity, this so-called third ventricle, in which it receives
additional heat and at the same time undergoes further thinning
as well as some kind of digestion and purification, the blood passes
on into the left ventricle and there undergoes a further change —
one which is characterized by the development of that element
which we call spirit, something clearer, more subtle, more pure,
more glorious than any known substance in the human body,
and therefore more nearly allied in its nature to celestial things.
This new element forms a friendly and very appropriate link
between the body and the soul ; it is the direct agent or instrument

FURTHER PROGRESS OF MEDICINE 291

of the latter, conveying to man the different faculties with which
he may be endowed.

From the left ventricle of the heart, alongside its auricle, two
arteries are given off. One of them, which is only furnished with
one tunic (as in the case of a vein) and which is called the arteria
venalis (pulmonary vein), carries to the lungs the blood which
they require for their nourishment, and breaks up into many
branches after entering these structures; the other artery is pro-
vided with two tunics and is called the grand artery (the aorta).
From the latter vessel are given off the numberless arteries which
are distributed throughout the entire body — ^vessels which trans-
port to every organ and structure both the blood which they need
for their nourishment and the spirit required for their revivifica-
tion. When this spirit passes into the ventricles of the brain it
is subjected to a new species of digestion, which converts it into
the spirit of the soul. Similarly, when it enters the liver it becomes
a nutritive spirit; when it enters the testicles, a generative spirit,
and so on through all the different organs.

CHAPTER XXIV

DURING THE LATTER HALF OF THE MIDDLE
AGES SURGERY ASSUMES THE MOST PROMI-
NENT PLACE IN THE ADVANCE OF MEDICAL
SCIENCE

During the first half of the fourteenth century, as has
been shown in the preceding chapter, Henri de Mondeville
was largely successful in rendering Paris the most promi-
nent centre of medical activity in France, if not in Western
Europe generally. His life, however, was short, and his
position as one of the leading surgeons of the French Army
subjected him to many and prolonged interruptions, for
which reasons he was not able to complete his excellent
treatise on surgery. No physician of the same intellectual
capacity and of equally strong character appears to have
been living in Paris at the time of De Mondeville 's death,
and consequently the importance of that city as a centre
of medical education diminished rapidly after that event.
On the other hand, the Medical School at Montpellier in
the southern part of France began at about this period,
under the influence of Arnold of Villanova (probably a
small town in Catalonia, Spain, in the diocese of Valencia),
to acquire importance.

Arnold of Villanova and the Medical School of Mont-
pellier.— Arnold of Villanova was born about 1240 A. D.,
of humble parentage. He obtained his early education in
a Dominican cloister, and afterward devoted all his energies
to the study of languages (especially Hebrew), theology,
philosophy, the natural sciences (physics, alchemy), and
medicine. Paris and Montpellier were the principal cities
in which he prosecuted those studies. Already as early

ADVANCE OF SURGERY 293

as the year 1270, Arnold had attained considerable celeb-
rity as a physician. Between the years 1289 and 1299 he
appears to have made his home in Montpellier, and to have
been very actively engaged both as a practicing physician
and as a teacher of medicine. It was in that city also that
he wrote the more important of his numerous medical
treatises. At a later period of his life he appears largely
to have lost his interest in medicine, for in 1299 we find
him acting as an ambassador from the King of Aragon,
whose private physician he was, to the Court of Philippe
le Bel, King of France, and deeply entangled, during his
stay in Paris, in disputes with the theologians of that city
respecting certain religious doctrines. He was also at the
same time busily engaged in championing various eccle-
siastic reforms which he was anxious to see inaugurated.
His opponents haled him before the tribunal of the
Inquisition and succeeded in having him cast into prison,
where he remained until he expressed a willingness to
retract the obnoxious opinions which he had advanced.
The same tribunal pronounced his treatise '*Z)e Adventu
Antichrists^ to be heretical. After these persecutions
Arnold endeavored to procure aid and comfort from Popes
Boniface VIII. and Benedict XI. The former was inclined
in his favor, but Benedict manifested no disposition to aid
him. Boniface's sentiments were doubtless influenced by
the fact that Arnold had treated him successfully for stone
in the bladder; and Neuburger incidentally states that, in
the effecting of this cure, not only medical and dietetic
treatment had been employed, but also two other meas-
ures— viz., the application of a bandage or truss which
encircled the loins snugly, and the wearing (by the patient)
of a magic seal ring upon which was engraved the effigy
of a lion.^ When Pope Clement V. (1305-1315 A. D.)
removed the papal seat from Rome to Avignon, in France,
Arnold was relieved from the charge of heresy and
reinstated in the respect of his contemporaries. He became
the trusted adviser of royalty, won the sympathy of
Jayme II. and of his brother, Frederic III., King of Sicily,

1 See remarks on the subject of amulets, etc., on pages 197, 198.

294 GROWTH OF MEDICINE

for Ms broad-minded views regarding religious matters,
and was both hated and feared by his enemies. According
to trustworthy chronicles, Arnold of Villanova died at sea
in 1311, within sight of the coast of Genoa, while he was on
a voyage (probably from Sicily) to visit the Court of
Clement V. In 1316 the Inquisition pronounced most of
his philosophical and theological writings heretical, and
ordered them to be destroyed.

A complete collection of the medical writings of Arnold
of Villanova, so far at least as they were then known to
exist, was printed at Lyons, France, in 1586. It is said
that many of the treatises which this author wrote have
been lost. Of those which have come down to our time
there are only three which call for any special comment —
Arnold's ^^Breviarium," a compendium of the practice of
medicine; his ^^ Commentary on the Regimen Salernita-
num, ' ' the sales of which, according to Neuburger, reached
an enormous figure ; and a work which bears the title
^^Paraholae medicationis secundum instinctum veritatis
aeternae, quae dicuntur a medicis regulae generates cura-
tionis morhorum.''^ (Basel, 1560.) The latter treatise,
which might with propriety be given the simple title of
** General Rules regarding the Treatment of Diseases," is
dedicated (1300 A. D.) to Philippe le Bel, King of France.
It contains a number of chapters on the principles of
general pathology, and others on special pathology and
therapeutics, \vith relation both to internal diseases and
to those which particularly interest the surgeon. It also
furnishes 345 aphorisms, many of which embody truths
of the highest importance and reveal the author to have
been a man of independent judgment, of wide experience,
and of a philosophical type of mind.

In the '^Parabolae" and the '^Breviarium/* says Neu-
burger, are to be found the most marked evidences of the
knowledge and ability which this great physician possessed.
He then adds : —

Arnold attached much importance to hygiene and the proper
regulation of the diet as effective measures in preventing diseases,
and he formulated an admirable set of rules for the ordering of

ADVANCE OF SURGERY 295

one 's manner of living. In these he gives prominence to the value
of baths, to the importance of taking a certain amount of physical
exercise, and to the selection of the right kinds of food. He also
describes in detail how wine may be utilized advantageously in
cases of illness. As regards the choice of remedies to be employed
he says that the physician should be guided by a very careful
consideration of the patient's age, temperament, habits of living,
etc. ; and, so long as there remains any doubt about the correctness
of the diagnosis, he should employ only mild and indifferent
remedies. The greatest care, he adds, should be exercised in the
preparation of the drugs that are to be administered, and one
should be very cautious about prescribing substances which have
not been sufficiently tried.

Arnold's writings are full of precepts which, like those
quoted above, show him to have been an excellent practi-
tioner of medicine as well as a man of sound common sense.
And yet at the same time he appears to have been more or
less tainted with the prevailing belief in astrology, in the
efficacy of amulets (as in the case of Pope Boniface referred
to on a previous page), "etc. His enemies gave him the
reputation of being a sorcerer upon whom the Devil had
bestowed the power of transmuting metals, — a reputation
which undoubtedly was based upon the fact that Arnold
interested himself greatly in alchemistic processes, often
referring to them as closely resembling such organic
phenomena as generation, birth, growth, etc. But, in our
judgment of the man, we should be careful to remember that
during the thirteenth century a belief in alchemy, astrology,
the efficacy of amulets, the influence of supernatural
agencies, etc., was almost universal. Even theologians
maintained that it was a sin for a practitioner of medicine
to neglect the influence of certain constellations. Indeed,
there are even to-day, not a few very sensible people in
whose minds exists a lingering belief in the interference of
supernatural agencies in human affairs.

The importance of the influence which Arnold of Villa-
nova exerted upon the progress of medical science, and
more especially upon the fame of the Medical School of
Montpellier, should not be estimated exclusively from the

296 GROWTH OF MEDICINE

value of his writings nor from the character of the work
which he performed as an instructor in that school. In the
thirteenth and fourteenth centuries physicians as a class
did not hold so high a position socially in Western Europe
as they were probably entitled to hold, and consequently
Arnold's later career, in which he showed himself to be a
wise, broad-minded, and very able statesman and as an
enthusiastic champion of greater liberty of thought in the
domain of religion, must be looked upon as having aided
very materially in raising the profession of medicine
to a higher rank and in adding eclat to the School of
Montpellier.

Contemporaries and Successors of Arnold of Villanova
at Montpellier. — During Arnold's lifetime there does not
appear to have been another physician at Montpellier who
could be compared with him in professional ability or in
general culture. There was one, however, who attained
considerable fame as a medical author, and who certainly
deserves at least a brief notice in this place — Bernard de
Gourdon, also known as Gordonius.

Bernard de Gourdon^ began teaching medicine in Mont-
pellier in 1285 A. D. He was the author of a treatise which
bore the title "LiZiwm Medicinae/' and which enjoyed an
unusual degree of popularity for a long period of time.
The earliest printed edition appeared in Lyons in 1474 and
was followed by several others in 1491, 1550, 1559 and 1574.
One of the latest editions is that of Frankfort, 1617. The
book was also translated into both French and Spanish.
In his description of the seven parts into which the book
is divided, the author says, by way of praising his own
work: ''In the lily there are many different kinds of
blossoms and in each one of these there are seven grains
of a golden character." The book treats of fevers, poison-
ings, abscesses, tumors, wounds and ulcers, of diseases of
the liver, spleen, kidneys and bladder, of affections of the
eyes, and of numerous other topics. The work as a whole,

2 A small town in the Department of Lot, France. The earliest Norman
ancestors of the Gurdon family in England are said to have derived their
name from that of this town.

ADVANCE OF SURGERY 297

says Neuburger, lacks depth and thoroughness, and reveals
the author to be overfond of employing drugs, especially
in combination, and by no means free from a belief in the
efficacy of amulets and other supernatural remedies. It
contains, however, one or two references to matters of
historical interest. For example, in Chapter V., Part III.,
mention is made of spectacles. So far as now appears, this
is the first time that these useful contrivances are referred
to in medical literature; and the casual manner in which
the author speaks of them suggests the idea that they had
already been known for some time. Possibly Roger Bacon,
who interested himself in researches in the department of
optics and who was a contemporary of Gordonius, may
have had something to do with the invention of spectacles.
At the ceremony of the marriage of the Duchess Juta
of Austria to Count Louis of Oettingen, at Vienna in 1319,
Pietro Buonaparte, the Podesta of Padua, created consid-
erable excitement by wearing a pair of spectacles which he
had received a short time previously from Salvino degli
Armati of Florence, the reputed inventor of these con-
trivances. It is not generally known that the printing of
books in very large and bold type during the latter part
of the fifteenth and the early part of the sixteenth centuries
was done expressly for the benefit of far-sighted readers —
this defect in vision characterizing a very large percentage
of the learned men of that period. The great number of
books which, during those early days of the art of printing,
were published in this style, emphasizes the fact that the
usefulness of spectacles was not generally appreciated
until after the lapse of many scores of years. Being very
expensive they were within the reach of only persons of
wealth, and, in addition, they were extremely difficult to
obtain. As late as during the year 1572, Augustus, Elector
of Saxony, moved by a strong wish to possess a pair of
spectacles, despatched a special messenger first to Leipzig
and then to Augsburg with instructions to purchase them
for him at the great annual fair. This agent, however, was
unsuccessful in the attempt, and, accordingly, in the
summer of 1574, he was instructed to ride on as far as

298 GROWTH OF MEDICINE

Venice. But, on arriving there, lie was informed that no
glasses would be ground before the month of October. He
was consequently obliged to remain in that city until the
autumn, at which time he sent word to his master that the
optician's charge for the instrument would be 50 thalers
(equivalent to $250 at the present value of money). The
Elector, it appears, was only too glad to pay this sum for
the coveted article. The first spectacles made were
equipped with only convex glasses, for the use of far-
sighted persons. It was not until about two hundred years
later that the art of grinding concave glasses for the relief
of short-sighted individuals was discovered.

Guy de Chauliac. — After the lapse of a few years there
appeared a man who was destined to add greatly to the
fame of the Medical School of Montpellier — not in the way
in which Arnold of Villanova had accomplished this result,
but by the publication of the first systematic treatise on
surgery which was written in Western Europe during the
Middle Ages. This man was Guy de Chauliac, about whose
early life very little is known. He was born in the village
of Chauliac, in Auvergne, France, toward the end of the
thirteenth century, his parents being simple peasants ; and
during early boyhood he probably attended the school
connected with the village church. His medical studies
were begun at Toulouse and completed at Montpellier.
But, at some time later than 1326, he went to Bologna and
perfected his knowledge of anatomy under the guidance
of Bertrucius, Mondino 's successor. After leaving Bologna
Guy visited Paris, arriving there subsequently to the
deaths of Lanfranchi, Pitard and Henri de Mondeville.
Although he remained in that great city only a short time,
he appears to have formed a warm friendship with several
of the instructors in the medical school.

About the year 1330 he took up his residence in Lyons.
His appointment to the position of Canon of Saint-Just,
a church which is located in that city, doubtless made it
necessary for him to adopt this course. And yet it is most
improbable that he spent much of his time in Lyons, for
his other duties — ^his attendance at the Papal Court in

ADVANCE OF SURGERY 299

Avignon, as private physician to three Popes in succession,
and the numerous calls made upon him for professional
advice and especially for surgical assistance by people
living at a long distance from Lyons — compelled him
repeatedly to absent himself from his home, sometimes for
several days at a time. In 1348 the plague visited Avignon
and carried off large numbers of people, the poet Petrarch's
Laura being one of the victims. During that terrible
epidemic Guy was most faithful in his devotion to Clement
VI. and to many others who needed his professional ser-
vices. In 1357 he was promoted by Innocent VI. to the
office of Provost of Saint- Just. In 1363 when — according
to his own declaration — he was an old man, he wrote the
treatise on surgery which has rendered his name famous
in the history of medicine. His death occurred about
July 23, 1368.

Guy was not, as some writers have asserted, a professor
of surgery in the University of Montpellier ; he was simply
a physician who had won at that institution the title of
** Master in Medicine" — the highest grade conferred by
the university authorities, and one which necessarily
implied that the recipient had given a certain number of
public readings on medical topics. And yet in actual
practice Guy manifested a strong preference for the man-
agement of diseases which demanded surgical treatment.
His writings, furthermore, make it clear that he had a
strong affection for the institution in which he had been
both a student and in some measure an instructor.

The book which Guy de Chauliac wrote, and which bears
the title ^^La Grande Chirurgie," is described by Mal-
gaigne,^ one of the most distinguished French surgeons of
the nineteenth century, in the following terms: **I do not
hesitate to say that, with the single exception of the book
written by Hippocrates, there is not a work on surgery, no
matter in what language written, which ranks higher than,
or is even equal to, the magnificent treatise of Guy de
Chauliac." Although most surgeons of the present day
will scarcely assent to praise of such an extravagant

8 Introduction to the "Oeuvres d'Ambroise Parg," Paris, 1840,

300 GROWTH OF MEDICINE

nature, they will undoubtedly agree in according to this
admirable author of the fourteenth century a high place
of honor in the Temple of Fame. Nicaise, the editor of
the most recent version of Guy de Chauliac's treatise,
speaks of him as the * ' founder of didactic surgery. ' ' From
1363 A. D., the date of its first publication in manuscript,
to 1478, a period of more than one hundred years, Guy's
book was universally regarded as the authoritative treatise
on surgery. But this branch of medicine, it must not be
forgotten, was, at that period of the Middle Ages, held in
very small esteem by physicians generally, and therefore
it is almost certain that Guy received no encouragement
whatever from any outside source. All the greater credit,
therefore, is due him for the admirable manner in which
he carried on the task which he had set before himself
during the last years of his life. Extraordinary as it
appears to us to-day, the Montpellier School of Medicine,
toward the end of the fifteenth century (that is, only a
comparatively short time after Guy's death), issued a
decree that thereafter their pupils were not to study nor
to practice surgery. From this and other well-authenticated
facts it appears that the prejudice which existed at that
period among physicians against surgery, was strong
enough to render them blind to the reality that it was
through the instrumentality of this very branch of medical
activity that the school at Montpellier had gained such an
increase in celebrity. They were unable to dispossess their
minds of the idea that operative and all other surgical
procedures were derogatory to the dignity of the educated
physician.

Guy de Chauliac wrote his treatise originally in Latin —
not the Latin of the classical authors, but a Latin greatly
deformed by the introduction of French, Arabic and
Provencal terms — ^barbaric Latin, as it is often called.
This language was commonly employed at the University
of Montpellier and at all other universities at that period ;
but, as Nicaise states, the style of his writing is so concise,
and at the same time so intelligible, that it would scarcely
be possible to translate it into modern French without the

ADVANCE OF SURGERY 301

loss of much of that which constitutes the charm of the
book. It was for the latter reason that he decided to write
his version of Guy's treatise in old French — the French
of the thirteenth and fourteenth centuries. In order that
our readers, most of whom are doubtless more or less
familiar with the finished language of modern French
literature, may see for themselves to what extent the latter
differs from its fourteenth century ancestor, I shall intro-
duce here a single paragraph of Nicaise's text. I have
chosen it, more or less at random, from the admirable
chapter which Guy has written on wounds in general.

Consequemment playes mortelles non necessairement, ains pour
la pluspart, sont petites playes, et superficielles es susdites parties,
et qui penetrent iusques a icelles et aux chefs des muscles. La
raison est, parce que si elles ne sont bien traitees, il advient qu'on
en meurt : et si sont bien traitees, on en guerit : ainsi que i 'ay veu
de la partie posterieure du cerveau, de laquelle sortit un peu de
la substance du cerveau, ce qui fut reconnu par I'offense de la
memoire, laquelle il recouvra apres la curation. le ne dis pas
toutesfois qu'on vesquit, s'il en sortoit toute une cellule, comme
Theodore raconte d'un cellier. Aussi Galen ne dit pas, de deux
blessez qu'il vit guerir en Smyrne du vivant de son maistre Pelope,
qu'il en fust sorty de la substance de cerveau, ains seulement que
le cerveau avoit este blesse: Ne, de celuy qu'il vist guery en
Smyme (comme il recite au huitiesme de V Usage), il ne dit pas
qu'il en sortit de la substance du cerveau, ains qu'il fust blesse en
I'un des ventricules gemeaux. Et avec ce on pensoit qu'il fust
guery par le vouloir de Dieu. Car si tous deux eussent este blessez,
il n 'eust gueres dure, comme il dit : et de ce il conclud 1 'utilite de
la duplication de quelques instruments, ainsi qu'a este dit cy
dessus en 1 'anatomic. Et tant de cettui-cy, que de ceux-la, la
guerison rare est fort rarement faite, comme il est dit au com-
mentaire dessus allegue.

There are many places in Guy's treatise where his
description of a surgical condition, or of the proper meas-
ures to adopt for the relief or cure of such condition, would
doubtless prove interesting to our readers, and would in
any event aid them materially in forming an independent
judgment as to the man's character in general and also

302 GROWTH OF MEDICINE

with regard to his qualifications as a surgeon. But all of
these descriptions, when rendered in their entirety into
English, occupy much space, and for this reason I shall
be obliged to furnish here merely a few extracts from some
of the more interesting portions of the text.

In the chapter which Guy devotes to wounds of nerves,
cords and ligaments — all of which structures were classed
by him, as well as by Galen, as belonging to the category
of nerves — this author divides them into punctured and
incised wounds, bruises and concussions. As to the first
variety he says that they may be divided into closed
punctured and open punctured wounds.

In the incised wounds two kinds may be distinguished : those in
which the nerve is incised in the direction of its length and those
in which the cut is made across the fibres. A further subdivision
is practicable, viz., into wounds accompanied by more or less
destruction of the substance of the nerve or its envelopes, and those
in which such loss has not occurred. Among other differences
worthy of mention are these: pain, spasmodic phenomena, and
abscess formation are present in certain cases and absent in others.
From all of which symptoms useful indications as to the treatment
needed may be deduced.

In the section relating to the treatment of such traumatic
affections of nerves, Guy makes the remark that the meas-
ures called for are, for the most part, the same as those
required for wounds involving simply the fleshy parts of
the body.

The element of pain, however, is one of the factors which dis-
tinguish wounds of a nerve from ordinary flesh wounds, and it
may necessitate some slight modification of the treatment. Aside
from this, one of the first things that should be done is to remove
from the wound all foreign substances; after which the edges of
the cavity should be brought together and held firmly in this
position by appropriate means. Last of all, care should be taken
to protect the parts. These are the general principles which are
to guide the surgeon's action. As to the special details, they must
depend upon the different conditions presented by each individual
case. Thus, for example, if we are dealing vdth a punctured wound
of a nerve, there will be no edges of an excavation to bring together.

ADVANCE OF SURGERY 303

If the object which produced the puncture is still lodged in the
tissues, it must, as a matter of course,- be withdrawn. After which,
the further measures to be adopted may be enumerated under the
following heads: careful regulation of the manner of living;
removal from the system of all material which — attracted to the
wounded part by the pain — might there cause irritation or inflam-
mation; and protection of the body against any harm that might
come to it through the occurrence of convulsions. These three
measures are indicated for all wounds of nerves. But, in the case
of a punctured wound, still other procedures should be employed,
as will be discussed under a fourth head.

The four heads mentioned by Guy may be briefly stated
in the following terms : I. The patient should be put upon
a light and very simple diet ; and, in addition, he should be
given a bed that is soft and humid {"humidus et mollis^ ^).
His surroundings should be kept quiet, and nothing should
be permitted to disturb his peace. of mind. 11. To protect
his tissues from the injurious influence of any superfluous
matters of an irritating nature that may be circulating in
the blood {i.e., cacochyme), a vein on the opposite side of
the body should be opened and a certain amount of this
fluid withdrawn. In certain cases, furthermore, it may be
well, in addition, to administer an aperient remedy. III. If
convulsions develop, the head, neck and the entire back
should be anointed with well-warmed linseed oil or common
(? olive) oil, as recommended by Galen. IV. Special
measures should be adopted for providing a free outlet for
any pus that may form in the deeper parts of the wound ;
and here again Galen recommends for this purpose the
-employment of one of several medicinal preparations which
he enumerates. ''But the more certain course," Guy adds,
*'is to make an opening in the skin either with the razor or
with the actual cautery (which latter, according to Henri
de Mondeville, is the better plan of the two), and then to
apply some subtle drying remedy which possesses the power
to penetrate into the deepest recesses of the injured
nerve — for example, savin oil." (Guy has a good deal
more to say on the subject of wounds of nerves, but the
few extracts given above should suffice. )

304 GROWTH OF MEDICINE

It is now a well-known fact that Guy de Chauliac was in
the habit of treating fractures of the thigh by the employ-
ment of the weight and pulley as means of keeping up a
continuing extension of the damaged limb. As his descrip-
tion of the method in question is very brief, it may not seem
out of place to reproduce it here. Translated into English
it reads as follows : —

As to the plan which I employ, it is this : After making fast to
the fractured thigh splints which extend down as far as the feet,
I reinforce the support which they give, either by placing the limb
in a box or by applying to its sides bundles of straw (appuye-
ments). [These are shown in the left-hand lower comer of Fig.
12.] I then attach to the foot a mass of lead as a weight, taking
care to pass the cord which supports the lead over a small pulley
in such a manner that it shall pull upon the leg in a longitudinal
direction. And if it then be found that there is not complete
equality between the fractured limb and its fellow as regards
length, the discrepancy may be corrected by gently pulling upon
the former. Every nine days the limb should be cautiously
handled; and at the end of about fifty days it will be found that
firm union has taken place.

One more remark seems to be called for in reference to the
fact that Guy de Chauliac, although he was avowedly a
surgeon, managed to win as great a reputation and as high
a social position as was possessed by any physician of that
period. The medical practitioner, it will be remembered,
held himself, during the Middle Ages, and was universally
held, to be a much higher type of man than the surgeon.
The relative standing of the two is well shown in the
accompanying sketch (Fig. 13), in which all the details
(attitude, head gear, gown, etc.) have evidently been care-
fully studied by the artist. Guy, however, through the
sheer force of his character, and also probably because he
was known to have won the highest medical honor (the
grade of ** Master of Medicine") w^hich it was in the power
of the university to confer, pushed his way to the top, and
held, for a period of twenty years, the position of private
physician to three Popes in succession — Clement VI.,
Innocent VI. and Urban V. In other words, the prevailing

f patlion gractsi i famltes Isone^ tt octro^tspau

tuuerenoptce eti oteuitbttfctgutaclamnefaut pcTtcfartfK ocSourses/rj^tttuitJiDS
ttaiiM aujcbtmffaiffeats&clhofhl Wftttit^itrtStpontlftttttntmft? ausmcMOoniw
irans ocuutcs m rtjacfu tiiu continnrutmeiu }> font t)cattte« rt ar ompKes e « pertbtmt

litres membtfg at ^ttUcmit.

.^^

FIG. 12. ONE OF THE WAI^DS IN THE HOTEL-DIEU OF PARIS,

As it appeared in the sixteenth century.

(From Chirurgie de Pierre Franco, edited by E. Nicaise, Paris, 1895.)

ADVANCE OF SURGERY 305

prejudices and jealousies were not sufficiently powerful to
block the triumphant career of this man of solid merit and
high character.

The State of Medicine and Surgery in Countries Other
than Italy and France During the Later Portion of the
Middle Ages. — From the account given by Neuburger it
appears that the seeds planted by the famous teachers of
medicine and surgery in Italy and France during the thir-
teenth and fourteenth centuries had begun to take root in
England and in the Low Countries to the north of France,
and were in fact already producing some good fruit in those
lands. Thus, for example, there have been handed down
to our time the names of four physicians who attained a
certain degree of eminence in England during the thirteenth
and fourteenth centuries — Gilbertus Anglicus, John of
Gaddesden, John Mirfeld and John Arderne.

Gilbertus Anglicus, who was the first English medical
writer to secure a certain degree of celebrity among the
physicians of continental Europe, wrote a compendium of
medicine that was commonly called the ^^Laurea anglica.*'
The book contains, along with some good original observa-
tions and the records of his own experience, not a few
wearisome theoretical discussions; and at the same time
it reveals the fact that the author was inclined to favor
remedial measures of a superstitious nature. In the last
chapter of his compendium, however, he makes the very
practical suggestion that distillation may be resorted to
when one desires to purify water that is contaminated.
Gilbertus, after obtaining his preliminary training in Eng-
land in the early part of the thirteenth century, visited
some of the leading schools on the continent, among others
those of Salerno and Montpellier, in which latter city he
appears to have practiced medicine for a certain length
of time.

John of Gaddesden, who is also spoken of as Johannes
Anglicus, was born about 1280 A. D. and died in 1361. He
was therefore a contemporary of Guy de Chauliac. He is
said to have been a Fellow of Merton College, Oxford, and
to have held the positions of Prebendary of St. Paul's,

306 GROWTH OF MEDICINE

London, and of private physician to the royal family. He
was also the author of a medical treatise which was gener-
ally known by the title, '^Rosa Anglica^^ (first printed in
1492). Neuburger speaks of this book as being an imitation
of Gourdon's ^^Lilium Medicinae,^^ but of a somewhat
inferior grade, and he quotes two or three passages which
show that medicine was in a very low stage of development
in England at the beginning of the fourteenth century.
Gaddesden, for example, advises his confreres to adopt the
rule of always securing their honorarium before they
undertake the treatment of a sick person. In another part
of the book he states that he treated one of the sons of
Edward II. for small-pox and secured excellent results,
not merely as regards the perfect restoration of his health,
but also as regards the complete prevention of any pitting
of his face. He attributes this success to the fact that he
enveloped the patient in a red cloth and took pains to have
every object in the vicinity of the bed draped in red.*

John Mirfeld, who lived during the second half of the
fourteenth century, completed his medical studies in
Oxford, then entered the Monastery of St. Bartholomew's
in London, and devoted himself thenceforward to work in
connection with the hospital belonging to that institution.
Among the books which he wrote there are a few that deal
with matters of interest to the physician. Such, for
example, are a glossary which bears the title ^^Synonyma
Bartholomaei/' a work called the ^*Breviarium Bartholo-

* ' ' Gaddesden had for a long time been troubled how to cure stone : ' At
last/ says he, in his Bosa Anglica, 'I thought of collecting a good quantity
of those beetles which in summer are found in the dung of oxen, also of the
crickets which sing in the fields. I cut off the heads and the wings of the
crickets and put them with the beetles and common oil into a pot; I covered
it and left it afterwards for a day and night in a bread oven. I drew out
the pot and heated it at a moderate fire, I pounded the whole and rubbed the
sick parts ; in three days the pain had disappeared ; ' under the influence of
the beetles and the crickets the stone was broken into bits. It was almost
always thus, by a sudden illumination, that this doctor discovered his most
efficacious remedies: Madame Trote [Trotula] of Salerno never confided to
her agents in various parts of the world the secret of more marvelous and
unexpected recipes." (From Jusserand's "English Wayfaring Life in the
Middle Ages.")

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ADVANCE OF SURGERY 307

maei/' and a shorter treatise on prognosis — the ^^ Specu-
lum.''^ None of these, however, possesses any special
importance.

John Arderne was born in England 1307 A. D., probably
obtained his medical training in Montpellier, accompanied
the English Army to France in the character of a
* ' Sergeant-Surgion, " and was present at the battle of
Crecy (1346 A. D.). During the succeeding twenty-four
years he practiced medicine in Wiltshire and Newark, and
then settled for the remainder of his life in London.
Although his practice included both internal diseases and
those which required surgical treatment, the great reputa-
tion which he acquired was based chiefly upon his success
in the latter field. Most of his writings, it appears, are
still in the form of manuscript. . They deal chiefly with
surgery and are accompanied by drawings of the instru-
ments which he employed. They possess one feature
which distinguishes them from the majority of medical
writings of the Middle Ages, viz., they abound in reports
of cases observed and treated by the author ; and, further-
more, the methods of treatment which he recommends are
in most instances rational and of a relatively simple nature.
The only one of Arderne 's treatises which has been printed
is that relating to fistula in ano. . It bears the title, *' John
Arderne — Treatises of Fistula in Ano, Haemorrhoids, and
Clysters ; from an early fifteenth-century manuscript trans-
lation," and is edited by D'Arcy Power, Early English
Text Society, Original Series, 139; London and Oxford,
1910. Arderne, we are told by Neuburger, puts forward
two claims : 1, that he succeeded in curing a large number
of cases of anal fistula, in proof of which he gives the names
of the persons upon whom he operated successfully, many
of whom are high up in the social scale ; and, 2, that no other
surgeon of whom he has any knowledge, either in England
or on the continent of Europe, is able to cure the disease.

The three English physicians of whom I have here given
very brief accounts, can scarcely be said to compare
favorably with those men who, during the same period,
brought fame to the medical schools of Bologna, Padua,

308 GROWTH OF MEDICINE

Montpellier and Paris ; and this fact suggests the question,
Do these men really represent the best type of physicians
who lived in England during the fourteenth century? The
great English poet Chaucer, in his ''Canterbury Tales"
(written at about the same period of time), furnishes us
with a portrait of a man who appears to have been well
informed with regard to the earlier Greek and Arabian
medical authorities as well as with the leading physicians
of his own time, and who in addition was clever both in
ascertaining the causes and nature of his patients ' maladies
and in prescribing for them the proper remedies. As this
physician's name is not mentioned, we cannot be sure that
he was not one of the three to whom reference has just been
made. By the description given by the poet, who probably
was personally acquainted with the man whose portrait
he draws, one is tempted to believe that he was a physician
of a higher type than any one of the three named above.
Chaucer 's account reads as follow : —

There was also a Doctor of Phisik,

In al this worlde was ther non him like

To speke of phisik and of surgerye ; .

For he was grounded in astronomye.

He kepte his pacient wondrously and we

In all houres by his magik natural.

Well coude he gesse the ascending of the star

Wherein his patientes fortunes settled were.

He knew the cause of every maladye,

Were it of cold, or hete, or moyst, or drye,

And where they engendered, and of what humour ;

He was a very parfit practisour.

The cause once knowen and his right mesure,

Anon he gaf the syke man his cure.

Ful redy hadde he his apothecaries.

To sende him drugges, and electuaries,

For eche of them made the other for to wynne ;

Their friendshipe was not newe to begynne.

Wei knew he the old Esculapius,

And Discorides, and eek Rufus ;

Old Ypocras, Haly and Galien ;

Serapyon, Razis, and Avycen ;

ADVANCE OF SURGERY 309

Averrois, Damascen, and Constantyn ;

Bernard, and Gatisden, and Gilbertyn.

Of his diete mesurable was he.

For it was of no superfluitee,

But of gret norishing and digestible.

With the names of the three English physicians men-
tioned above, there should be associated that of Jehan
Yperman, who was born in Ypern, Flanders, during the
latter half of the thirteenth century, obtained his profes-
sional training in Paris under Lanfranchi, and then, in
1303 or 1304, accepted the position of Physician to the
Hospital of Belle, a small Flemish town. In 1318 he settled
permanently in Ypern, his native city, and in a compara-
tively short time won completely the confidence and esteem
of his fellow townsmen through his attentiveness to their
wants when they were ill and through the great skill which
he manifested in his work as a surgeon. He died 1329 A. D.

Yperman 's writings deal with both medical and surgical
topics. Of those which have been translated from the Latin
into French are: **La chirurgie de maitre J. Yperman,"
Anvers, 1863; **Traite de medecine pratique de maitre
J. YpeTman," Anvers, 1863; and **Traite de medecine
pratique de maitre J. Yperman," Anvers, 1867. A perusal
of these works, says Neuburger, easily convinces one that
Yperman was not only a skilful and clever surgeon,
but also a physician of independent judgment and wide
experience.

Revival of the Practice of Dissecting Human Bodies. —
It was in Italy that dissecting was carried on during the
fourteenth century more vigorously than elsewhere in
Europe. At first the only persons who made such investi-
gations for scientific purposes were individual physicians
or groups of physicians; and, in addition, they were
obliged to carry on the work in a secret manner — that is,
by stealing from recently dug graves the corpses which
were necessary for such studies. It is related, for example,
that in 1319 one of the teachers in the Medical School at
Bologna and four of his pupils were brought before the
Court of Law under the charge of having clandestinely

310 GROWTH OF MEDICINE

disinterred, for purposes of dissection, the body of a man
who had been hung for some crime. At first the authorities
merely winked at such transgressions, but at the same time
they made no attempts to have the law against dissecting
annulled or at least modified. Then, at a somewhat later
period, the conviction became general among the intelligent
members of the community that, unless work of this nature
were officially sanctioned, no real advance in the knowledge
of human anatomy could be made, and — what was probably
of even greater importance in their estimation — that
Bologna might at the same time lose a good deal of its
superiority over its rivals as a centre of learning; and
accordingly it was found practicable to grant the desired
sanction with many modifying restrictions attached. Then,
with the further lapse of time, other medical schools fell
into line and secured from the authorities similar privileges
for their teachers and pupils. Thus, in 1368, the Senate
of Venice authorized the medical school of that city to make
a public dissection of a human body once every year; and,
eight years later, the University of Montpellier acquired
the same privilege. In 1391 John I. of Spain was equally
generous in his treatment of the Medical School at Lerida.
After the opening of the fifteenth century no further
difficulties of a serious nature were experienced by the
teachers of anatomy in procuring at least some material
for dissecting purposes, and with each succeeding year such
facilities steadily increased. Unfortunately, however, there
did not follow a corresponding increase in the knowledge
of human anatomy. As a matter of fact, it was not until
during the sixteenth century that any really valuable work
was accomplished in this branch of medicine. Guy de
Chauliac, in the first chapter of his treatise {^^La Grande
Chirurgie^^), gives the following description of the manner
in which Bertrucius taught anatomy in Bologna at the
beginning of the fourteenth century, and from this account
it is easy to understand why the additions to our stock of
information in this department of medicine were so few and
so unimportant during this long period. The so-called
dissecting, it clearly appears, was in reality a not very

ADVANCE OF SURGERY 311

profitable combination of purely anatomical work of a
primitive character and a search for evidences of patho-
logical changes. The clinical history of the individual
whose body was undergoing examination does not seem to
have played any part in the investigation. Here is
De Chauliac's account: —

After placing the dead body on a bench, my master proceeded
with his instructions, devoting thereto four separate sittings.
At the first of these he passed in review those parts or organs
which are concerned in nutrition; his reason for considering them
first being that they are the earliest to undergo decomposition.
At the second sitting he devoted himself to the spiritual organs
of the body; at the third, to the animal parts; and at the fourth,
to the extremities. Following the example furnished by Galen in
his commentary on the book entitled "The Sects," he maintained
that there were nine things which should be taken into considera-
tion when one examines the different parts of the body, to wit:
their situation ; their nature, color, bulk, number, and shape ; their
connections or relations; their actions and their utility; and the
diseases which may affect them. Conducted in this manner the
study of anatomy, he maintained, may prove helpful to the physi-
cian in recognizing diseases, in making prognoses, and in selecting
a suitable plan for treatment.

Puschmann, quoting from Hyrtl, says that Avhen Pro-
fessor Galeazzo di Santa Sofia, who had been called from
Padua to Vienna to fill the Chair of Anatomy in the
medical school of that city, made his first public dissection
of a human body (1404 A. D.) in the Biirgerspital, the
sittings covered a period of eight days ; at the end of which
time he collected as much money as he could from those
who had attended the course, and turned it over to the
treasurer of the Faculty. Then followed a period of twelve
years during which not a single public dissection of a
human body was made in Vienna. In 1440 the Faculty were
greatly rejoiced over the prospect of receiving from the
authorities the body of a criminal who was to be hung on
a certain day ; but, when the time arrived and the body had
actually been delivered to them, they were grievously
disappointed by the sudden coming to life of the supposed

312 GROWTH OF MEDICINE

corpse. Instead of dissecting him for the benefit of science,
the doctors bestirred themselves in the man's behalf,
obtained a pardon in due form, and sent him back to his
home in Bavaria under the escort of the college janitor.
Not very long afterward, however, he committed a fresh
crime, and this time was effectively hung. History does
not state whether the dissection then came off, or not.

The Medical Faculty of the University of Tiibingen
established the rule in 1497 that one human body should
be publicly dissected every three or four years; it being
understood that during the progress of the dissection the
professor should read aloud to the class appropriate
portions of Mondino's treatise on anatomy. The instruc-
tion in this department of medical science was of the same
general character in all the other universities of Germany
at that period. Anatomical drawings, of a very crude type,
were employed as substitutes for actual dissection.

At Padua, in Northern Italy, the science of medicine had
already before the end of the first half of the fifteenth
century made a decided advance, in proof of which several
circumstances may be mentioned. In the first place, the
importance of the study of anatomy had by this time
become so generally recognized that no special difficulty
appears to have been encountered in securing the erection,
in 1446, of an anatomical theatre; and during this same
period several physicians connected with the medical
school acquired considerable celebrity by their publication
of important treatises on topics belonging to the domain
of general pathology and therapeutics, and by the wide
influence which they exerted as teachers. Among the
number of those who helped in these ways to spread the
fame of the Medical School of Padua may be mentioned
Hugo Benzi, Antonio Cermisone, Giovanni Savonarola and
Bartolommeo Montagnana.

Hugo Benzi (or Hugo of Siena) taught philosophy as
well as medicine in different institutions of learning — at
Pavia, Piacenza, Florence, Bologna, Parma, Padua and
Perugia. His death probably occurred at Ferrara about
the year 1439. In addition to commentaries on Hippocrates,

ADVANCE OF SURGERY 313

Galen and Avicenna, he wrote several practical works
{^^Consilia'^) on such topics as periodical insanity, sto-
machic vertigo, naso-pharyngeal polypi, epilepsy, lachrymal
fistula, etc.

Antonio Cermisone was a native of Padua, became a
teacher of medicine first in Pavia and afterward in Padua,
wrote several useful treatises about various diseases, and
finally died about 1441.

Giovanni Michele Savonarola — the grandfather of the
celebrated Girolamo Savonarola, who was burned at the
stake for heresy 1498 A. D. — held the Chair of Medicine
in Padua from about 1390 to 1462, and also subsequently
for a certain length of time in Ferrara. He was the author
of a number of treatises on practical medical topics — such,
for example, as fevers (first published in Venice in 1498),
the art of preparing simple and compound aqua vitae
(Basel, 1597), an introduction to the practice of medicine
(1553), the baths of Italy and of the rest of the world
(Venice, 1592), the different kinds of pulse, etc. (Venice,
1497) — and he also wrote a large work covering the entire
field of medicine and modeled on the pattern of Avicenna 's
*' Canon." The book is divided into six parts, each of
which is preceded by an introduction that is devoted to the
anatomico-physiological bearings of that particular part;
and here, in addition, there are to be found scattered
throughout the text references to surgical procedures.
Among the references of this character the following
deserve to be mentioned as worthy of some notice: the
description of a speculum for use in operations upon the
interior of the nose; a reference to direct laryngoscopy;
the description of an instrument closely resembling the
well-known syringotome ; the treatment of curvature of the
spine by mechanical means, etc. The book also reveals the
fact that, already at this period of the history of medicine
(the middle of the fifteenth century), physicians were
beginning to take a more active part than they had pre-
viously done in the management of confinement cases,
which as a rule were left entirely to the care of midwives.
The records also show that medical men were interesting

314 GROWTH OF MEDICINE

themselves more and more, as time went on, in sanitary-
science as applied to municipal affairs. In most commu-
nities the need for such was indeed most urgent at that
time. The reforms of this nature were pushed -with special
vigor in those parts of Italy which were governed by that
enlightened ruler of the Hohenstaufen family, Frederic II.,
King of Sicily and Roman Emperor. The cultivation of
personal hygiene was also pursued very systematically
during the later Middle Ages, the Regimen Salernitanum
serving as the guide in such matters.

Taken all together the conditions in the physician's
world were in anything but a promising state toward the
end of the fifteenth century ; but the dawn of better times,
of modern medicine, was near at hand, and already signs
of its approach were beginning to be recognizable in
different parts of Western Europe.

CHAPTER XXV

BRIEF HISTORY OF THE ALLIED SCIENCES-
PHARMACY, CHEMISTRY AND BALNEOTHER-
APEUTICS

During the excavations carried on at the site of Pompeii,
there were discovered three houses which bore every
appearance of having been occupied by apothecaries.
Among the objects found in these buildings were : A bronze
box equipped with the apparatus required for mixing
ointments; a few surgical instruments; several glass
receptables which had evidently at some earlier period
contained fluid or semi-fluid pharmaceutical preparations,
but which, at the time when the excavations were made,
presented merely a deposit of some solid but easily friable
substance at the bottom of the vessel ; and quite a variety
of drugs in the form of pills, tablets, powders, etc. At first,
the impression prevailed that these must have been the
houses of apothecaries, but subsequently the discovery, in
each instance, of the house sign representing a snake with
a pine cone in its mouth (the symbol of Aesculapius)
satisfied the authorities that these particular buildings
had belonged to physicians. Indeed, as a matter of fact,
no good reasons have thus far been found for believing
that apothecaries, in the modern acceptation of the term,
existed in even the largest cities of Greece and Italy until
a much later date.

Pharmacy in Its Infancy. — All through the Hippocratic
period and during the years when Alexandria was at the
height of its prosperity as the great centre of medical
activity, it was customary for the physicians to prepare
their own drugs. The same is true of the best physicians

316 GROWTH OF MEDICINE

belonging to the Augustan period; they were not willing
to put their trust in the drugs which had been prepared in
the shops where such things were usually sold.

In the second century of the present era Galen gave the
definition that a remedial drug, or ' * Pharmakon, " was
something which, when taken into the living body, produces
an alteration in its component tissues or organs, whereas
foods or nutrient elements simply cause an increase of the
parts. He attached great importance to such character-
istics as purity, freshness, care in handling, etc. It was
his custom to prepare with his own hands the different
combinations of simple remedial agents which he admin-
istered to his patients, and he kept these combinations, as
well as the simple drugs of the more costly kinds, carefully
stored in locked wooden boxes in a room which was
devoted to this special purpose and which was termed the
* * Apotheke. ' ' Originally, therefore, the ' * apothecary ' ' was
simply the person who had charge of this room in which
the drugs and spices were carefully ** placed to one side"
(dTTo, rldr}^) for safc keeping. At a later period, when the
caretaker became also the compounder of drugs, another
word of a more comprehensive significance — that of
''pharmacist" — gradually supplanted the term apothecary.

There is another word, ''antidote," which has very
materially changed its significance during the lapse of
centuries. Galen, for example, employed this word as a
synonym of pharmakon — a simple remedial agent, and
medical writers continued using the term in this sense
during the following thirteen or fourteen centuries. The
word commonly employed, by mediaeval physicians, to
signify "pharmacopoeia," was " antidotarium. " In
modern times the word "antidote" signifies only an agent
which neutralizes a poison.

Galen took a very great interest in everything relating
to the subject of drugs, and sometimes made long journeys
for the purpose of securing certain plants or roots which
he was unable to procure near home or which he was very
anxious to obtain in a more perfect condition than was
possible when they were purchased from the regular deal-

HISTORY OF THE ALLIED SCIENCES 317

ers. ** Simple remedies," he declared, **are pure and
unadulterated, and produce effects in only one direction.
It is the business of pharmacology to combine drugs in
such a manner — according to their elementary qualities of
heat, cold, moistness and dryness — as shall render them
effective in combating or overcoming the conditions which
exist in the different diseases. ' ' Galen 's interest in pharma-
cology materially aided the advance of medical science in
other ways. He systematized the existing knowledge of
materia medica and infused some measure of orderliness
into the therapeutics of his day. The success of his efforts
in this direction did not become manifest until after he had
been dead about fifty years ; but, if his ideas were slow in
meeting with general acceptance, they took such deep root
in the minds of physicians that to-day in Persia Galen's
system of therapeutics is the only one generally received
as authoritative. Although the facts do not warrant our
making the same statement with regard to Western and
Southern Europe, it is nevertheless true that our dispen-
satories still continue to honor the memory of this great
physician by bestowing the name of ** Galenical Prepara-
tions" on a large group of pharmaceutical combinations.
It is scarcely possible to state with any degree of posi-
tiveness at what date pharmacists, in the modern sense
of the term, came to be recognized as constituting a
separate and honorable class in every well-organized
community. It is known, however, that in Syria and Persia,
during the eighth and ninth centuries of the present era,
not a few of the leading physicians were the sons of
apothecaries. Honein, for example, of whose career I
furnished a brief sketch in Chapter XIX., was the son of
an apothecary; and the careful manner in which he was
educated during his youth justifies the belief that his father
must have been a man of some cultivation and not at all like
the general average of that class of men of w^hom Galen
speaks so disparagingly. But even at that early period
there certainly were individuals who were skilled in the
pharmaceutic art, for Berendes {op. cit.) tells us that
Dioscorides {circa 100 A. D.) describes minutely the

318 GROWTH OF MEDICINE

manner of preparing ^'Oisypum." Oisypnm is identical
with the modern ' * Lanolin " or ' ' Lanolinum, ' ' and is a pure
fat of wool. Mention is made of the preparation by four
different authors of medical treatises during the following
sixteen centuries — ^viz., by Aetius in the sixth, by Paulus
Aegineta in the seventh, by Nicolaus Myrepsus in the
thirteenth, and by Valerius Cordus in the seventeenth.
Subsequently to the latter date no further mention of the
preparation is to be found in any of the pharmacopoeias
except the French Codex of the year 1758, in which it is
classed among the simple remedies under the title of
''Oesipe." Finally Liebreich, toward the end of the nine-
teenth century, brought the preparation once more into
favor under the name of ''lanolin." The fact that it
remained in complete oblivion for such very long periods
of time is easily explained by the statement which Berendes
makes: *'It was a troublesome ointment to manufacture,
and consequently the apothecaries disliked it and resorted
to all sorts of falsifications. ' '

With the advance of the Arab Renaissance pharmacy
gradually became a regular established occupation in every
fairly large city in the East. It is known, for example,
that the first public apothecary shop in the city of Bagdad
was established during the eighth century of the present
era under the caliphate of Almansur; and about the same
time, probably a little earlier, there existed at Djondisabour
a similar pharmacy in connection with the school and
hospital of the Bakhtichou family. The training of an
apothecary in those days was probably the same as that
of the physician. Originally pharmacists were called
' ' Szandalani, " probably because they dealt largely in
sandal wood.

The materia medica furnished by the Arab physician
Rhazes in the different works which he has written, is
unusually rich in simple elements, the majority of which
are always drugs of a rather mild action; Greece, Persia,
Syria, East India and Egypt were the sources from which
they were derived. Beside the simple elements, Rhazes
mentions a number of composite preparations of drugs.

HISTORY OF TEE ALLIED SCIENCES 319

As not a few of the latter required very careful manipu-
lation, it may safely be inferred that the Arabian
apothecaries of the ninth century had already acquired
considerable skill and experience in their special field of
work.

At Salerno, during the first half of the twelfth century,
pharmacy began to assume a position of considerable
importance. The work which was- prepared by Nicolaus
Praepositus, and which was known as an ' * Antidotarium, "
furnished quite full information with regard to the char-
acters and therapeutic uses of nearly 150 different drugs.
According to Berendes this work served for several cen-
turies as the basis of later pharmacopoeias. One of its
notable features is the importance which the author attaches
to the duty of weighing very carefully each of the drugs
that enter into the composition of a given preparation, of
gathering certain vegetable products at the right season,
and of paying strict attention to their quality and to the
manner of preserving them.

In 1140 A. D., Roger, King of Naples and Sicily, pro-
mulgated a law which defined what should be the proper
relations between physicians and apothecaries; and about
one hundred years later (1241 A. D.) Frederick II.
amplified and gave greater precision to this law, thus
establishing what was practically an Institute of Apothe-
caries. The following provisions constitute the essential
features of the law : —

1. The physician and the apothecary shall have no business
interests in common.

2. The physician shall not himself conduct an apothecary shop.

3. In each department of the kingdom two respectable men,
selected by the Faculty at Salerno, shall be assigned the duty of
furnishing sworn statements to the effect that all the electuaries,
syrups, and other preparations of drugs kept for sale in a given
apothecary shop, have been made according to the established
prescriptions and are offered for sale only in that state.

4. In the case of those preparations which ordinarily do not
keep for a longer time than one year without spoiling, the price
at which they are to be sold shall be at the rate of 3 Tarreni (about

320 GROWTH OF MEDICINE

30 cents) per ounce; while those which ordinarily remain un-
changed during a longer period, shall be valued at 6 Tarreni per
ounce.

At the time which we are now considering, it was not the
custom, owing largely to the expensiveness of writing
paper, to deliver to the pharmacist a written prescription.
Instead, the physician first gave his instructions in person,
and then, after he had seen the mixing and other steps of
the apothecary's work properly performed, he carried the
preparation to the patient's house.

Long before the middle of the fifteenth century apothe-
caries had become thoroughly well established throughout
Central and "Western Europe. Among the statutes of the
Medical Faculty of Erfurt, Germany, there has been found
one which dates back to the year 1412 and which says : —

The student of medicine, before he applies for the Bachelor's
Degree, should spend one month in the spring of the year, in an
apothecary's establishment, in order that he may familiarize him-
self with the proper manner of preparing clysters, suppositories,
pessaries, syrups, electuaries and other things necessary for a
physician to know.

The first work which was really worthy of being termed
a treatise on materia medica was published in 1447. It
bore the title, "Compendium Aromatariorum, " and was
written by Saladin of Ascolo, the private physician of
Prince Antonio de Balza Ossino of Tarentum. Berendes
says that it was a work of much practical value.

The First Indications of the Beginning of Chemistry. —
Up to a comparatively recent date it has been customary
to speak of Geber as the first practical chemist and the first
writer among the ancients who appreciated the important
part which chemistry was likely to take in medicine and
philosophy at no distant period of time. But to-day, as
appears from the researches made by M. Berthelot about
1893, we are compelled to abandon the belief that such a
person as Geber existed, and shall have to adopt the more
commonplace view that the science of chemistry represents
a gradual development from the much older alchemy. We

HISTORY OF THE ALLIED SCIENCES 321

may define the latter branch of knowledge as the science
of transforming copper and brass into gold and silver.
During the first two or three centuries of the Christian era
there existed a firm belief that such a transformation had
actually been accomplished, and in confirmation of the
correctness of this statement it may be said that Zosimos
of Panopolis, one of the leading philosophers of Alexandria
during the fourth century of the present era, and a man
who was considered by his contemporaries, as well as by
all later alchemists, to be perhaps the greatest authority
in this branch of knowledge, speaks in unmistakable terms
in his cyclopaedic work on alchemy (28 volumes), of a
certain tincture which possesses the power of changing
silver into gold, and also of a ** divine water" or fluid which
is capable of effecting many different transmutations.
There can therefore be no reasonable doubt that in the
earlier centuries of the Middle Ages the learned men of
Alexandria accepted alchemy as a well-established agency
of great power. From the sixth century to the thirteenth
this science was cultivated with great assiduity by the
Arabs in the academies which they established in Cordova
and other cities of Spain ; and it was from the latter region
that the belief in alchemy spread to all the countries of
Western Europe, gradually gaining strength up to perhaps
the fifteenth century.

It was during the thirteenth century that the so-called
'* philosophers' stone" came to be considered the most
effective agent in transmuting the baser metals into silver
and gold, and there were not a few who even believed that
this as yet non-existent stone possessed the power to in-
crease longevity, to confer health, and to give a prosperous
issue to one 's undertakings. It was not the rabble, but the
very best and most highly educated men in the community
who, during the thirteenth century, took the most active
interest in alchemy and the philosophers' stone. Arnold
of Villanova, Raymund Lullus, Roger Bacon, Albertus
Magnus, and, to a lesser degree, the famous theologian
Thomas Aquinas were all believers in the art of the magir
cian. And even more extraordinary than this is the fact

322 GROWTH OF MEDICINE

that in Germany men of this stamp continued for two or
three centuries longer to cherish a belief in the reality of
alchemistic processes. Even Martin Luther (1483-1546),
the great reformer, did not hesitate to express his approval
of '^the black art," as is shown by the following quotation
from one of his writings: —

The art of alchemy is commendable and belongs in truth to the
philosophy of the ancient wise men, a fact which pleases me greatly,
not merely because of the intrinsic merits and usefulness of the
art in the matter of distillations of vegetables and oily fluids and
sublimation of metals, but also because it serves as such a noble
and beautiful symbol of the resurrection of the dead at the last
day of judgment. (Berendes.)

Another celebrated character who dabbled in the black
art was Johannes Faust, who was born in 1485, obtained
his degree of Bachelor of Arts at the University of Heidel-
berg, and died in 1540 in Staufen in Breisgau. Professor
Scherer of Berlin says that *'he was a great braggart,
never failed to create a sensation wherever he went, and
had the conceit and effrontery to pass himself off as a
scientist among the learned men of his day. He called
himself the philosopher of philosophers, a second Magus.
He maintained that he was both a physician and an
astrologer, and claimed that he could restore the dead to
life, and could predict future events from a mere inspection
of fire, air and water."

But although the persistent and wonderfully energetic
activities of the alchemists failed to find the philosophers*
stone, or to transmute the baser metals into silver and gold,
they placed in the hands of man the key to a knowledge
of chemistry, that branch of science which was destined
in later years to play such an important part in pharmacy,
in agriculture and in other industries. Thus we owe to
alchemists the discovery of many processes and the inven-
tion of many apparatus which serve as the groundwork
of modern chemistry. Some of the more important of
these are the following: The use of the spirit lamp; the
invention of tubular retorts ; the production of potash and

HISTORY OF TEE ALLIED SCIENCES 323

soda by burning the hard deposit which collects in wine
casks as well as various marine plants; the oxidizing of
certain metals (iron, lead, copper, quicksilver and anti-
mony) ; the making of metallic arsenic, of wine of anti-
mony, of sulphate of iron, of chloride of silver, of acetic
acid and of many other chemical products ; the purification
of metals by the use of lead, etc.

Supplementary Data Relating to Balneotherapeutics. — I
have referred to this subject on several occasions in the
course of the earlier chapters of this history, but always
without entering very much into details. This policy was
adopted, partly because the facts upon which a satisfactory
sketch of the growth of balneotherapeutics might be based
were not very numerous, and partly because of the neces-
sity of gaining space for more important matters.

The principal facts to which I made reference were:
First, that before the Christian era the employment of
baths in a variety of different ways for therapeutic pur-
poses was universal in the East; and, second, that in the
city of Rome during the centuries immediately following
the birth of Christ, facilities for this kind of treatment
were provided on a most lavish scale — as in the baths of
Agrippa (27 A. D.), of Titus (79 A. D.), of Caracalla
(211 A. D.), and of Diocletian (302 A. D.). I may now add
that the warm springs of Aachen (Aix-la-Chapelle), Baden-
Baden and Wiesbaden, in Central Europe, and Bath, in
England, were known to the ancient Romans, and were
utilized by them to some extent for therapeutic purposes ;
but it was not until a much later period that they and the
less well-known springs of Schwalbach, Driburg, Warm-
brunn, Goeppingen and Gastein began to be actively
frequented for remedial purposes. By the beginning of
the sixteenth century it had become a very popular thing
for sufferers from all sorts of ailments to resort to these
and other European springs. The history of the thera-
peutic employment of mineral waters belongs, however, to
the period of modern medicine rather than to that which
I have been considering in the present volume.

PART III
MEDICINE DURING THE RENAISSANCE

CHAPTER XXVI

IMPORTANT EVENTS THAT PRECEDED THE
RENAISSANCE— EARLY ATTEMPTS TO DIS-
SECT THE HUMAN BODY

Important Events Immediately Preceding the Renais-
sance.— Three hundred years before the Christian era
Erasistratus and Herophilus made, at Alexandria, Egypt,
an attempt to develop a correct knowledge of anatomy by
means of dissections of human corpses, but the political
and religious conditions at that time were not favorable
to scientific work, and therefore the success attained was
of a very restricted character. Then, during the succeeding
three or four centuries, this early movement gradually died
out, and no further contributions to our knowledge of
human anatomy were made until toward the end of the
second century of the present era, at which time Claudius
Galen, a man of giant intellect and tireless energy, did his
best to supply the anatomical knowledge so urgently
needed. But the deeply rooted prejudices of that age
against dissections of the human body lay like an insur-
mountable barrier across his path and forced him to confine
his efforts to the dissection of those animals whose bodily
construction resembled more or less closely that of man.
Galen believed that the anatomy which he thus evolved
for the guidance of his professional brethren would satisfy
all their legitimate wants of this nature, and he proceeded
to build upon this faulty and unstable foundation an equally
faulty physiology. History records the extraordinary fact
that Galen's belief in the sufficiency of his anatomy and
physiology for all the reasonable needs of physicians and
surgeons was so well grounded that during the following

328 GROWTH OF MEDICINE

thirteen or fourteen centuries nobody dared to cast the
slightest suspicion upon the trustworthiness of these
foundations of the science of medicine. Then followed,
during the fourteenth and fifteenth centuries, an awakening
which seemed to affect all departments of human activity.
This movement, which is commonly termed the ''Renais-
sance, ' ' developed at first very slowly, and reached a note-
worthy degree of momentum only toward the middle of the
fifteenth century, about which time there occurred several
events that contributed greatly to strengthen and per-
petuate the movement. Such were, for example, the
employment of gunpowder in the wars of Western Europe ;
the invention of a method of manufacturing paper — a
discovery which led to the abandonment of the much more
expensive parchment, and prepared the way for the
invention of printing in its different forms; the taking
of Constantinople by the Turks in 1453; the discovery of
America in 1492 ; and, finally, the Reformation inaugurated
by Martin Luther. Let us pass in review very briefly each
of these events, in order that we may the better appreciate
how the science of medicine, in the short space of time
represented by a couple of centuries, made a greater
advance than it had previously made in the course of
several hundred years.

The employment of gunpowder in warfare robbed the
knight of the protection which he had previously enjoyed
from the wearing of metal armor, and thenceforward his
life was as much imperiled in battle as was that of the foot-
soldier, who was not permitted to protect his person in this
manner. Thus were the two upper classes of the commu-
nity, the nobles and the bourgeois, in any conflict which
might arise between them, placed more nearly upon a
footing of equality. The ultimate result showed itself in
an increased importance, an increased prosperity, of the
middle class or bourgeoisie, from which the physicians
chiefly came. Indeed, feudalism from this time forward
rapidly ceased to exist.

The discovery of paper, an excellent and relatively cheap
substitute for parchment, facilitated wonderfully the spread

EVENTS PRECEDING THE RENAISSANCE 329

of knowledge. Parchment, the material upon which books
were written, was expensive and was at times difficult to
obtain; both of which circumstances rendered books so
costly that only a few physicians were able to become the
owners of the important standard medical works of that
period — such, for example, as the Hippocratic writings,
Galen's treatises, the surgical manuals of de Mondeville
and Guy de Chauliac, the pharmacopoeia of Dioscorides,
and still other books of lesser value. And, if a satisfactory
method of manufacturing paper had not first been dis-
covered, the benefits growing out of the invention of
printing in 1467 would have been far less than they actually
proved to be. Some idea of the magnitude of these benefits
may be formed from the following statement of facts. The
demand for books, after the invention of printing, became
so great that the presses were kept almost constantly busy.
At first, according to the record furnished by Haeser,
Venice and Rome took the lead in supplying this great
demand for books; the former city printing 2978 and the
latter 972 volumes between the years 1467 and 1560; but,
during a later period (1500-1536), Paris outstripped Venice
with a total of 3056 volumes, and Strassburg advanced to
the second place with a showing of 1021 volumes printed
during the same period of time. Thanks to the great
diminution in the market price of books that resulted from
the two inventions named — the manufacture of paper and
the introduction of printing — almost every physician in
fairly prosperous circumstances was able at that period
to purchase the relatively few medical treatises which
issued from the presses; and, besides, new authors were
thenceforth stimulated to put their experiences into print.
Among the very first medical books printed the following
deserve to be mentioned: —

(In Germany.) Buck der Biindth-Erznei, by Heinrich von
Volsprundt, 1460. — Das huch der wund Artzeny. Handwirckung
der Cirurgia von Jyeronimo hrunschwick, 1508. — Das Feldtbuch
der Wundtartzney, by Hans von Gerssdorff, 1517.

(In Italy.) Avicennae opera, arabice, 1473. — Guillelmi de
Saliceto cyrurgia, 1475. (A French translation was published at

330 GROWTH OF MEDICINE

Lyons in 1492.) — Celsi de medicina liber, etc., 1478. — Guidonis de
Cauliaco cyrurgia, 1490. (A French version was printed in Lyons
in 1498.)

(In France.) Christophori de Barzizus de fehrihum cognitione
et cura, 1^94:.— Bernard de Gourdon, traduction de son "Lilium
medicinae," 1495.

When Constantinople fell into the hands of the Turks
in 1453, many of its Greek inhabitants, and particularly
those belonging to the more highly educated classes, fled
to Western Europe in order to escape from the tyranny
of the invaders. Not a few of these refugees brought with
them to Italy and France copies of the works of the classical
Greek authors, and on this account, as well as because of
their willingness to give instruction in their native tongue,
they met with a cordial welcome wherever they took up
their new abodes. Their arrival in Italy happened at a
most propitious time, for the interest in Greek literature
was at that period just beginning to develop among Italian
scholars. Previously, Greek had been an almost unknown
tongue in Italy. Petrarch, for example, is reported to
have said in 1360 that he did not know of ten educated men
in that country who understood Greek; and there is no
evidence to show that the number of such men increased
between 1360 and the time when the refugees from Constan-
tinople arrived. Many of the works of greatest importance
to physicians — such, for example, as the writings of
Hippocrates, of Galen, of Rufus of Ephesus, of Oribasius,
of Alexander of Tralles, and of several other classical
medical authors of antiquity — were accessible (in the
original) only to those who were familiar with the Greek
tongue. Consequently the arrival of these refugees from
Constantinople constituted a most important event in the
history of European medicine.

The discovery of America by Christopher Columbus in
1492 owed its origin in part to the restless spirit of
adventure which was abroad in Spain and Italy at that
time, and also, in perhaps still larger measure, to the hope
of gain which might be expected to follow the discovery of
a shorter and more direct route to India. As regards the

EVENTS PRECEDING THE RENAISSANCE 331

attainment of the latter object, the great explorer failed,
but his discovery of a new continent resulted eventually in
bringing great wealth to the rulers of Spain, in stimulating
maritime commerce, and in broadening men's views with
regard to every phase of human activity. The addition
of a few new drugs to the pharmacopoeia was a further
result of some importance. Luther's efforts to reform the
government and doctrines of the Church undoubtedly gave
a great impetus to the Renaissance and therefore to the
growth of the science of medicine. Men learned to use
their reasoning powers with greater freedom, and as a
result our knowledge of the structure of the human body
(anatomy) and of the working of its complicated machin-
ery, both in health (physiology) and in disease (pathology),
made astounding advances. And it is to the consideration
of these fundamental branches of medical knowledge that
we must now turn our attention.

Early Attempts to Dissect the Human Body. — Already
as early as during the first half of the fourteenth century
physicians began to appreciate the fact that further
progress in the knowledge of medicine was not to be
attained otherwise than by a more profound study of human
anatomy than had been made up to that time; and they
realized that it was only by means of actual dissections that
this more profound study might be made. Various in-
fluences, however, co-operated to hinder such study. In
the first place, the people at large were thoroughly imbued
with the idea that dissecting a human corpse was an act of
desecration, and consequently it was by no means safe for
a physician to do any work of this character except in the
most secret manner. Then, in addition, it was commonly
believed — and this belief persisted even up to a compara-
tively recent date — that the bull which Pope Boniface VIII.
issued in 1300 — and which declared that whoever dared to
cut up a human body or to boil it, would fall under the ban
of the church — ^was intended to cover dissections for pur-
poses of anatomical study. The recent investigations of
Corradi, however, show (Haeser, p. 736 of the third
edition) that this bull was not intended to apply to dissec-

332 GROWTH OF MEDICINE

tions for scientific purposes, but simply to put an end to
the practice of cutting up human corpses and boiling the
separate sections in order to obtain the bony framework
in a condition suitable for transportation from Palestine
to Europe, — a practice which had grown to be very common
among the Crusaders.

Mondinus' ''Anatomy," which was published in 1314,
reveals the fact that, during the early part of the fourteenth
century, several private dissections were made. As might
be expected, from the primitive character of the illustrations
that accompany the text of Mondinus' work, these dis-
sections were carried out in a very imperfect manner, for —
to mention only a single example — this author admits that
he made no attempt to investigate the deeper structures
of the ear, as such an examination would necessitate the
employment of violent measures, ' ' which would be a sinful
act."

The archives of the Bolognese School of Medicine con-
tain an item which reveals the active interest taken in
anatomy by the students of that day. It reads as follows :
''At Bologna, in 1319, several of the Masters stole from
a grave the corpse of a woman who had been buried two
days before, and then turned it over to Master Albertus
to dissect in the presence of a large number of students."
At the Medical School of Montpellier, in the south of
France, the Faculty obtained permission in 1376 to dissect
the corpse of an executed criminal once every year; and
the records show that the school actually availed itself of
this privilege in the years 1377, 1396 and 1446. Felix
Platter, who afterward became one of the most distin-
guished physicians of Basel, Switzerland, pursued his early
medical studies at the latter university during the years
1552-1557 ; and, in the diary which he faithfully kept during
this period, he reveals in an interesting manner what
difficulties as well as dangers he experienced, first, in
reaching Montpellier from his home in the eastern part of
Switzerland, and, second, in obtaining greater opportuni-
ties for acquiring a genuine knowledge of anatomy than
the school itself afforded in its official course. Although,

EVENTS PRECEDING THE RENAISSANCE 333

owing to lack of space, I shall not be able to quote in full
the appropriate portions of this most interesting narrative,
I will furnish an abridged English translation of the story
as it appears in Platter's journal or diary. In all its more
important details the account reads as follows ; —

Our little party was composed of three persons, viz., Thomas
Schoepfius, the schoolmaster of St. Pierre ; a Parisian by the name
of Robert who happened to be passing then through Basel on his
way to Geneva; and myself, a lad of sixteen. We traveled on
horseback and all three of us were armed with rapiers. My outfit,
which was handed to me by my father shortly before our departure,
consisted of two extra shirts and a few pocket-handkerchiefs,
wrapped up in a piece of waxed cloth. In the matter of funds for
the journey I received from my father three crowns in silver and
four gold pieces which, for further security, he sewed into my vest.
In addition, he presented me with a rare piece of silver money
which had been issued by the Cardinal Mathieu Schiner, of the
Canton de Valais, who personally commanded the Swiss soldiers
in their successful combat with the troops of Louis the Twelfth, at
Marignan. It was a coin, therefore, which possessed considerable
historical value. My mother also bestowed upon me a gold coin
(a couronne). As a last injunction my father begged me not to
forget that, in order to procure the money which he had just placed
in my hands, as well as that which he had already paid for my
horse, he had been obliged to mortgage his property.

We left the city at nine o 'clock on the morning of Oct. 10th, 1552,
and at the same moment the news reached us that the Plague had
made its appearance in Basel. This was a most depressing piece
of intelligence, especially as we were already in great fear that the
army of the Emperor Charles the Fifth, which was at that time
on its way to the siege of Metz, would utterly destroy our city.

We arrived at Berne early on the morning of Oct. 12th, and,
after leaving our horses at the inn, The Falcon, lost no time in
visiting the objects of interest in that ancient city, not forgetting
the bear pit, in which there were at that time six of these creatures.
In the afternoon we resumed our journey toward Fribourg, and
very soon overtook a newly married couple. As they were traveling
on horseback like ourselves, and were following the same route
for a certain distance, we all agreed to keep together. While
passing along a shady part of the road the bride's dress became
so firmly entangled in the branches of an apple tree that, failing

334 GROWTH OF MEDICINE

to stop the horse, she was left suspended in the air by her skirts.
I immediately dismounted and helped her to regain her feet, to
adjust her disordered dress, and to resume her seat in the saddle.
On arriving at Fribourg we put up at the inn called La Croix
Blanche, and soon discovered that almost everybody in the town
spoke French, a language with which Thomas and I, who were
Germans, were not familiar ; but, thanks to our companion Robert,
the Parisian, we experienced no difficulty whatever in making all
our wants known and in securing all the information that we
desired.

On the following day, Oct. 13th, it was raining hard when we
left Fribourg, and we were soon wet to the skin. After passing
through several small villages we stopped for refreshment at an
inn in the picturesque town of Romont, and at the same time
availed ourselves of the opportunity to have our clothes dried.
Then, having satisfied our appetites, we resumed our journey in
the direction of Lausanne ; but we did not get very far on our way
before we discovered that Thomas had disappeared. "We were of
course obliged to wait for him, and, by the time he had rejoined
the party, darkness and a thick fog combined to render further
progress very difficult, and we soon realized that we had lost our
way. We wandered up and down for some time without encounter-
ing a barn or building of any kind in which we might find shelter
from the rain and secure a measure of protection from the robbers
who, according to common report, infested that part of the
country. Finally, however, we discovered a small village; but,
when we applied for a night 's lodging, not one of the householders
was willing to receive us. So we engaged the services of a young
peasant to act as our guide, and with his assistance we finally
reached a mean-looking inn in a village called Mezieres, which was
composed of a few widely scattered houses. We entered the tavern
and found several Savoyard peasants and some beggars seated at
the long table of the bar-room; they were engaged in eating roasted
chestnuts and black bread, which they washed down with copious
draughts of a liquor called piquette. They unceremoniously
examined our weapons and acted with great rudeness toward us
in other respects. The woman who kept the house said she had no
other room which she could place at our disposal, and our first
impulse therefore was to resume our journey immediately after
we had finished our meal of black bread and chestnuts; but, after
careful reflection, we came to the conclusion that such a course
might prove fraught with considerable danger. So we decided to

EVENTS PRECEDING THE RENAISSANCE 335

remain awake and watch for an opportunity to make our escape.
Very soon afterward these half-intoxicated men lay down on the
floor before the fire in the adjoining hall- way or vestibule and fell
into a sound sleep. Our guide then confessed to us that, while at
work in the stable, he had heard them planning to waylay us on
the highway at an early hour of the following day. As soon,
therefore, as, we heard them all snoring lustily we very quietly
slipped out of the house. Our score having already been paid
earlier in the evening, and our horses having been left saddled and
bridled in the stable, we mounted and took our departure by a road
which led at first in a direction different from that in which we
were supposed to be traveling. We experienced no further trouble
on this part of our journey and in due time reached Lausanne.
When we told the people at the inn about our experience at
Mezieres they replied that we might consider ourselves most fortu-
nate, as almost every day there occurred, in the forest through
which we had passed {la For it du Jorat), a murder or some other
deed of violence.^ It was plain, therefore, that we had had a narrow
escape from death.

In the further course of our journey along the north shore of
the lake we reached the city of Geneva on Oct. 15th. When I called
upon John Calvin, to whom my father had given me a letter of
introduction, he said to me: "My Felix, you arrive at the right
moment, for I am now able to give you an excellent traveling
companion for the remainder of your journey — to wit, Dr. Michel
Heronard, a native of Montpellier. " This Dr. Heronard, as I
learned subsequently, was a Protestant who played a prominent
part in the religious disorders which, a few years later, greatly
disturbed the peace of that city

On the 30th of October — just twenty days after we set out from
Basel — we entered the city of Montpellier, and I lost no time in
hunting up Laurent Catalan, the apothecary, at whose house I
expected to reside during my stay in that city.

Platter had now, after a long and dangerous journey,
reached one of the three greatest medical schools of that

1 Some weeks later our fellow voyager, Thomas Schoepfius, wrote to me that,
on the return journey, he learned at Berne that "Long Peter," the leader of
the MeziSres robbers, had been apprehended by the authorities and executed
for his crimes; and that, when stretched on the rack, he had confessed, among
other things, that he had tried to murder and rob some students who passed
through M6zi6res on their way to Lausanne.

336 GROWTH OF MEDICINE

period, and it was his hope and expectation that he would
here be able to acquire a correct and intimate knowledge
of human anatomy. He was already aware that this
knowledge could be satisfactorily obtained in only one
way — that is, by dissecting the human body; and accord-
ingly he availed himself of every possible opportunity,
during the five years which he spent at Montpellier, to
accomplish this purpose. From the somewhat superficial
examination which I have made of the record furnished
by the diary, it appears that only five or six official lessons
or demonstrations were given by the professor of anatomy
during the period of time named; but — as every student
of medicine knows — instruction of this character is of
relatively small value; and Platter himself seems to have
realized fully the truth of this statement, for during
the second year of his stay at Montpellier he joined
a secret band of nocturnal grave-robbers who were
determined at all hazards to obtain the material needed for
self-instruction. The following brief description of one
of the raids made by this band of eager searchers after
knowledge will convey a good idea of the manner in which
the work was conducted : —

Our first excursion of this kind was made on Dec. 11th, 1554.
As soon as it was really dark our fellow student Gallotus guided
us, along the road that leads to Nimes, to the Augustinian Monas-
tery, which is situated about half-way between Castelnau and the
Verdanson brook. Here we were received by a monk called
Brother Bernard, a bold and determined fellow, who had disguised
himself for the business in hand. At midnight, after we had par-
taken of food and drink, we started out, sword in hand, for the
cemetery which is located close to the church of Saint Denis. Here
we dug up with our hands a corpse which had been interred that
very day; and, having lifted it out of the pit by means of ropes,
and wrapped our cloaks around it, we carried the body on two
canes as far as Montpellier. Then, having concealed our load
close to the postern, alongside the city gateway, we summoned the
keeper and begged him to get us some wine, as we were dying of
thirst and very tired. "While he was absent in search of the wine
three of our party slipped in through the passage and carried the
corpse safely to Gallotus' house, which was only a short distance

EVENTS PRECEDING THE RENAISSANCE 337

from the gate. The gate-keeper returned in due time with the
wine, and did not appear to have the slightest suspicion of the trick
that we had played upon him. It was now three o'clock in the
morning.

The control exercised by the authorities over the practice
of dissecting human corpses differed very appreciably at
different dates in different parts of Europe. Thus, for
example, orders were issued to the Italian bishops during
the latter part of the fourteenth century to put a stop to
further dissections, and for a period of over one hundred
years these orders accomplished the purpose desired. On
the other hand, the Emperor Charles the Fourth adopted
a more liberal course : from the year 1348 on he permitted
dissections of human corpses to be made without hindrance
in Prague, Bohemia, but his liberality in this particular
appears to have been of little use, for there is no evidence
to show that the knowledge of anatomy made any appre-
ciable advance anywhere in Europe until after the begin-
ning of the sixteenth century.

Gabriel Zerbi of Verona (1468-1505) published at Venice
in 1502 the first modern treatise on human anatomy that
deserves to receive special mention. Pagel speaks of it
as containing fairly good descriptions of different parts
of the body. Zerbi held the Chair of Medicine, Logic and
Philosophy in the University of Padua, and lectured first
in that city, next at Bologna, and finally at Rome. One
incident in his career may prove of interest to the reader
as showing the fearful risks to which a practicing physician
in those days was sometimes exposed. The incident was
of this nature : —

A wealthy pacha in Constantinople, failing to obtain relief from
his malady at the hands of the native Turkish doctors, summoned
an Italian physician from Venice. Zerbi, whom the ruling Doge
invited to accept the summons, sailed immediately for Constanti-
nople in company with his two sons who were mere lads. The
treatment which he inaugurated proved promptly successful, and
Zerbi, having been handsomely remunerated for his services, was
already on his way back to Venice when his ship was overhauled by
a swift-sailing caique on board of which were the sons of his recent

/

338 GROWTH OF MEDICINE

patient, who — as the story goes — had celebrated his recovery by
eating and drinking to excess. This debauch promptly caused his
death — probably by cerebral apoplexy ; but the sons were convinced
that it was the result of poison administered by Zerbi, and accord-
ingly they lost no time in starting out to capture the supposed
murderer. Their first act, on reaching the vessel which they were
pursuing, was to kill the younger of the two sons, in the presence
of the father, by sawing his body in two lengthwise. Then they
killed Zerbi himself in the same manner.

Tiraboschi, the first historian of Italian literature (1731-
1794), is mentioned by Dezeimeris as his authority for this
terrible tale. The events here narrated occurred in 1505.

At the beginning of the sixteenth century — the period
with which our history now has to deal — ^the only available
knowledge of anatomy was that which had been supplied
by Galen in the third century of the Christian era, and
which had been handed down through all the intervening
centuries as something absolutely correct and not to be
challenged. But the time had arrived when men were no
longer willing to accept as truth the teachings of any
individual until they had subjected them afresh to the most
searching investigations; and thus it came about that a
group of remarkably able men devoted all their energies,
during the greater part of the sixteenth century, to a very
critical study of human anatomy. As the work accom-
plished by these men constitutes a very important chapter —
perhaps the most important chapter — ^in the history of
medicine, I may be pardoned if I devote a disproportion-
ately large amount of space to the consideration of the
careers of the more prominent of these founders of modern
anatomy, and to an enumeration of the details of the work
which they accomplished, and which furnished the most
complete verification of the truth stated by Francis Bacon,
Lord Verulam (1561-1626), in the following words (trans-
lation) : —

Man has no other means of getting at and revealing the truth
than by induction coupled with a never-tiring, unprejudiced
observation of nature and an imitation of her operations. Actual

EVENTS PRECEDING THE RENAISSANCE 339

facts must first be collected, and not created by a process of
speculation.

One of the earliest and most thorough students of human
anatomy was Marc Antonio della Torre (1473-1506), who
belonged to an honorable family of Verona, several mem-
bers of which had attained distinction as physicians. He
planned to publish a treatise on anatomy, and, with this
object in view, secured the assistance of Leonardo da Vinci
(1452-1515), the celebrated painter, architect and civil
engineer, to make life-size pictures of the parts which he
had dissected with such care. But, after the latter had
completed many of the drawings which were intended to
serve as illustrations for the projected treatise, Della Torre
unexpectedly died, and the book was never finished. Quite
a number of the drawings, however, found their way to
England, and for many years past they have been carefully
treasured at Windsor Castle and in certain private
collections. If Delia Torre's life had been spared it is
highly probable that his treatise on anatomy, equipped with
illustrations copied from this great artist's dramngs, would
have constituted a formidable rival of Vesalius' famous
work.

Not long after this event it became the rule, among the
leading painters and sculptors of the Renaissance period,
to pay a great deal of attention to the study of human
anatomy. The museums of Central and Southern Italy
contain quite a large number of anatomical drawings that
were made by Michael Angelo, by Raphael and by other
great masters of that period. Doubtless many of my
readers recall seeing, in the Cathedral of Milan, Marco
Agrate's (1562) extraordinary masterpiece, in the form
of a life-size black marble statue which represents Saint
Bartholomew standing erect, and carrying on one arm the
folded skin of his entire body. In this statue all the muscles
and bony prominences are modeled with perfect accuracy.
It is a remarkable work of art.

CHAPTER XXVII

THE FOUNDERS OF HUMAN ANATOMY AND
PHYSIOLOGY

Among the earliest physicians of this period to inculcate
the importance of substituting a correct knowledge of
anatomy for the frequently incorrect descriptions that had
been prepared by Galen and handed down through the
succeeding centuries, were the following : Jacques DuBois
of Paris (1478-1555), who was perhaps better known by
his latinized name of "Sylvius"; Guido Guidi (died in
1569), who was also known as "Vidus Vidius"; and
Winther of Andernach, a small city on the Rhine. These
three men, all of whom taught anatomy at Paris, were
commonly considered the best anatomists of that early
period. DuBois was further entitled to the credit of having
been the first physician to inject blood-vessels with a
material that renders them more easily visible, and also
the first person in Paris to dissect a human corpse. It was
from these men that Vesalius, who afterward became such
a famous anatomist, received his first practical instruction
in this branch of medical science. Nothing further need
be said here of DuBois, but brief sketches of Guido Guidi
and of Berengarius of Carpi, another contemporary
anatomist of considerable distinction, deserve to find places
in our history of this period. Vesalius' facetious remark
that ''Winther of Andernach never used a knife except for
the purpose of dissecting his food" absolves us from the
duty of saying anything further about his career as an
anatomist.

In 1542 Francis the First, King of France, gave a great
impulse to the study of medicine by calling Guido Guidi
from Florence, Italy, to teach that science in the College

HUMAN ANATOMY AND PHYSIOLOGY 341

de France, an institution which he had founded at Paris
in 1530. Guidi, upon his arrival in Paris, was at once most
cordially received, both by those who were to be his col-
leagues and by the King. Francis bestowed upon him a
suitable gift, appointed him to the position of First
Physician (Archiater) at his Court, and assured him that
he would receive an ample salary during his residence in
the French metropolis. In 1547, after the death of Francis
the First, Guidi returned to his home in Florence, where
Cosimo dei Medici, at that time the head of the Florentine
Republic and a little later Grand Duke of Tuscany
(Cosimo III.), made him his First Physician and gave him
the appointment of Professor of Philosophy in the Univer-
sity of Pisa. Not long afterward Guidi was transferred
to the Chair of Medicine. He retained this position almost
up to the time of his death (May 26, 1569), and during this
long period Cosimo bestowed upon him various ecclesiastic
honors, which not only increased his social rank but added
materially to his financial resources.

Dezeimeris says that, while Guidi does not deserve to
be placed, as an anatomist, in the same rank with Vesalius
and Fallopius,^ he merits full credit for the very important
service which he rendered the physicians of his day by
placing within their reach translations of certain Greek
treatises relating to surgical topics — such treatises, for
example, as those of Hippocrates on ulcers, on wounds of
the head, on the joints and on fractures (with Galen's
comments), Galen's treatise on fasciae, and that of Ori-
basius on ligatures and other surgical contrivances.

Apart from his merits as a worker in the field of medical
science, Guidi occupies a creditable place in the history
of medicine as a fine type of the well-educated and kindly
disposed physician, as the following testimony given by
Benvenuto Cellini, the distinguished Florentine sculptor,
shows : —

On the occasion of my visit to Paris I made the acquaintance of
Messer Guidi, and I wish to state in what a very friendly manner

1 Also often spelled ' * Falloppius. ' '

342 GROWTH OF MEDICINE

I was received by that noble citizen of Florence and excellent
physician, the most virtuous, the most lovable, and the most
domestic man whom I have ever met.

Guidi 's treatise on anatomy was first published at Venice
(under the editorship of his nephew) in 1611 — i.e., forty-
two years after his death. His translations from the Greek
treatises of Hippocrates, Galen and Oribasius will be found
in the work which bears the title ^^Collectio Chirurgica
Parisina,'^ Paris, 1544.

Berengarius of Carpi (a small town in Northern Italy),
who died in 1530, is pronounced by Kurt Sprengel a worthy
predecessor of Vesalius. He was Professor of Anatomy,
first at Pavia and then at Bologna (from 1502 to 1527), and
he is reported to have dissected more than one hundred ( !)
cadavers during that period. Fallopius and Eustachius
were among his pupils, and it was their opinion that he
did more than anybody else to revive the interest in
anatomical work. The famous sculptor, Benvenuto Cellini
(1500-1571), is authority for the statement that Berengarius
was not only an experienced anatomist and practicing
physician, but also a very skilful draughtsman; the three
works which he published being illustrated with a certain
number of original woodcuts that are not without interest
both to the anatomist and to the lover of art.

Andreas Vesalius (1514-1564) was born at Brussels, of
German parents whose home was located at Wessels on the
Rhine, — ^whence the name ''Vesalius." His father was the
apothecary of the Princess Margaretha, Charles the Fifth's
aunt, and several of his ancestors had been physicians of
considerable distinction. At Louvain he received, in early
youth, a thorough training in the Latin, Greek and Arabic
languages and also in mathematics. When he was about
eighteen years of age, he visited Montpellier and afterward
Paris, at which latter city he received practical instruction
in anatomy from the three men whose names I have
mentioned in the preceding paragraph — ^viz., Guido Guidi,
Jacques DuBois and Winther of Andernach. The instruc-
tion in anatomy given in Paris at that period (about 1533)
consisted in interpretations of Galen's teachings, in dis-

HUMAN ANATOMY AND PHYSIOLOGY 343

sections of a few animals, and in occasional demonstra-
tions— which never lasted longer than three days — of the
easily accessible parts of a human cadaver. Scanty as were
these sources of information, Vesalius cultivated them with
the greatest zest. From time to time his teacher, DuBois,
noting the interest which his pupil took in anatomy, and
recognizing his fitness for imparting instruction, assigned
to him the special duty of rehearsing, in the auditorium,
before his fellow students, the essential facts of the day's
lecture. After war had been declared between the Emperor
Charles the Fifth and Francis the First, King of France,
Vesalius left Paris and returned to Louvain, where he
began lecturing on anatomy. These lectures constituted
the very first attempt at anything like systematic instruc-
tion in anatomy that is known to have been made at that
ancient university. It was while he was engaged in this
work that Vesalius, in order to become the possessor of an
entire human skeleton, — a thing of which he felt a very
great need, — ventured to remove from the gallows, outside
the city, the cadaver of a criminal. This, as Haeser
declares, was an act of great boldness and full of peril.

The life of a military surgeon attached to the army of
Charles the Fifth, which was the life that Vesalius led dur-
ing the following year or two, was not sufficiently attractive
to divert his mind seriously from his favorite study; and
it is therefore not surprising that we find him, at the age
of twenty-three, accepting from the Senate at Venice the
appointment of the professorship of anatomy at the
University of Padua. When he entered upon this new work
Vesalius felt considerable uncertainty as to the correctness
of the anatomy which he was then teaching, and it is there-
fore easy to understand why his first three lectures were
based entirely upon the teachings of Galen ; but, before he
had finished the third one of the series, he made up his
mind that he would cut loose from the anatomy of the ape
and confine himself to that of the human subject, as was
then being revealed to him more and more perfectly from
his own dissections. The stock of knowledge which he had
thus begun to accumulate, increased steadily until, after

344 GROWTH OF MEDICINE

seven years of teaching at Padua, Bologna and Pisa, at
each of which schools of medicine he gave courses in
anatomy of seven weeks' duration, and after conducting
the most painstaking dissections of a number of human
cadavers, he finally declared that he was ready to publish
his great treatise on anatomy. Some of his friends, fore-
seeing clearly what a storm of protest the new book would
arouse among the followers of Galen, urged him to postpone
for a time its publication; but a few others agreed with
him that it should be issued without further delay.
Accordingly Vesalius sent the manuscript of his work at
once to the printers at Basel, and the book was finally
published in June, 1543, before its author had attained his
twenty-ninth year. Its title was ^^De corporis humani
fabrica/' and it was provided with exceptionally fine pic-
torial illustrations, most of which were drawn, as is gener-
ally believed, by John de Calcar, one of Titian's pupils.
A second edition, superior in every respect to the first, was
published in 1555. In comparison with this great work
the few treatises written by Vesalius in later years are of
minor importance.

Vesalius may rightly be considered the founder of modern
anatomy, for he was the first to furnish correct information,
based on actual dissections of the human cadaver, respect-
ing quite a large number of the more important anatomical
relations; and by this very act he won the further credit
of having dealt the first effective blow toward the dethrone-
ment of Galen, the man who, next to Hippocrates, —
probably even more than Hippocrates, — had exercised, by
his teachings in nearly every department of medical
science, almost despotic sway over physicians for consider-
ably more than one thousand years. At this distance of
time, it is hard to realize what a startling effect was pro-
duced by the announcement of the discovery of so many
errors in Galen's scheme of anatomy. Albert von Haller,
the great authority on medical literature, speaks of
Vesalius' book as an "immortal work"; and, although its
title would lead one to suppose that it deals only with the
construction of the human body, an examination of its

ff

FIG. 14. ANDREAS VESALIUS.

(After the portrait by Van Calcar in the Royal College of Surgeons,
London.)

Copied from the reproduction publi.shed in the Nederlandsch Tijdschrift
voor Geneeskunde, Jan. 2, 1915.

HUMAN ANATOMY AND PHYSIOLOGY 345

contents reveals the fact that it contains in addition quite
full information regarding physiology and pathological
anatomy, as well as many details relating to comparative
anatomy. Perhaps the most marvelous thing about this
book is the fact that its author completed his work before
he had reached his twenty-eighth year. It may also interest
the reader to learn that, prior to 1914, the University of
Louvain possessed a copy of Vesalius' great work printed
on vellum and illustrated with many drawings in colors;
but I am unable to say whether this beautiful volume did
or did not escape destruction at the hands of the ruthless
men who invaded Belgium during the summer of that
memorable year.

When the human mind has adjusted itself, in the course
of years, to consider certain beliefs and ideas as settled
truths, it comes as a painful shock to be told that these
beliefs are erroneous and that new ones must take their
places. This is precisely what happened when Vesalius'
book was first published. From one end of Europe to the
other there was a very great stir among the well-educated
physicians ; the more liberal minded being ready to accept
at once the genuineness of the new anatomy, whereas
others, — and possibly they represented the larger num-
ber,— acting under the influence of personal jealousy or
perhaps blinded by the belief that it was impious not to
accept without questioning the descriptions made by
Galen, were scandalized by the boldness of Vesalius in
asserting that many of the statements made by this great
medical authority were incorrect. Jacques DuBois, whose
name has been mentioned by me on a previous page, was one
of the most bitter of Vesalius' assailants. In a pamphlet
which he published in Paris in 1551 he even went so far as
to speak of his late pupil as ' * a crazy fool who is poisoning
the air of Europe with his vaporings." On account of
their former pleasant relations, and also because DuBois
was at that time an old man, Vesalius made no reply to
these attacks; but when Bartholomaeus Eustachius, Pro-
fessor of Anatomy at Rome, one of the most celebrated
anatomists of that period, and a man of his own age, entered

346 GROWTH OF MEDICINE

the lists as the champion of Galen, Vesalius took up the
challenge, left the work upon which he was then engaged,
and began a tour of visits to the universities of Padua,
Bologna and Pisa, for the express purpose of disproving,
by the aid of numerous dissections, the statements made
by his antagonists. Throughout this tour he was received
everywhere with enthusiasm, the older men among the
teachers of anatomy vying with the younger in manifesting
the strength of their approval. The entire journey, says
Haeser, was from beginning to end a series of the most
brilliant triumphs. But, notwithstanding this vindication,
which most men would have accepted with the greatest
satisfaction, Vesalius returned to his home in Brussels only
to find that the bitter attacks made by his enemies had not
ceased. This depressed him greatly, for he was not
philosophical enough to recognize the facts that jealousy
was at the bottom of this ill feeling toward him, and also
that sufficient time had not yet elapsed for the news of his
triumphant vindication to travel from Italy to Belgium.
While suffering from this fit of the blues he committed to
the flames all his books and manuscripts. These latter, it
appears, contained not only the fruits of many years of
laborious anatomical and physiological research, but also
a large number of memoranda relating to pathological
anatomy.

In 1556, complaints having reached the ears of Charles
the Fifth to the effect that the sin of dissecting human
corpses was greatly on the increase, this monarch decided
to refer the question to the Theological Faculty of the
University of Salamanca, in the northwestern part of
Spain, for an authoritative opinion. The reply which these
broad-minded theologians sent to the Emperor was most
satisfactory. It is reported to have been expressed in the
following words: "The dissection of human cadavers
serves a useful purpose and is therefore permissible to
Christians of the Catholic Church. ' ' This decision did not
of course put an immediate end to the harsh criticisms and
petty persecutions of the bigots ; but, as the years went by,
it was noted that the work of scientific research in human

HUMAN ANATOMY AND PHYSIOLOGY 347

anatomy and physiology acquired greater freedom of
action, and it is fair to assume that this result was largely
due to the famous decision to which I have just referred.

Shortly after Vesalius had retired, as stated above, from
active participation in anatomical research work, he was
called by Charles the Fifth to serve him in the capacity of
private physician. During this service, which lasted for
several years, he visited, in company with the Emperor,
many of the principal cities of Europe ; and then, when the
latter abdicated the throne of Spain, — for Charles was not
only Emperor of the Holy Eoman Empire but also King
of Spain, — Vesalius became the private physician of Philip
the Second, Charles' son and successor on the Spanish
throne. This long period is largely a blank in the history
of Vesalius. Toward the end he got into trouble with the
Inquisition and was obliged, as a means of escaping the
punishment of death, to undertake a voyage to the Holy
Sepulchre in Jerusalem. While he was in that city he
received an official invitation from the Senate at Venice
to fill the Chair of Anatomy at Padua. He then at once
turned his steps toward Italy, doubtless very happy over
the prospect of once more engaging in anatomical work;
but he was shipwrecked on the coast of the Island of Zante,
October 2, 1564. Thirteen days later, before he had com-
pleted his fiftieth year, he died from starvation and
exposure. A memorial tablet was placed in one of the
neighboring churches on the island, and in 1847 his Belgian
compatriots erected a suitable monument to his memory
in the city of Brussels.

Admirable as was Vesalius' treatise on human anatomy,
it was soon discovered that it was deficient in certain
particulars. Not a few of the descriptions, for example,
were incomplete, and there were also a number of parts or
organs for which no descriptions whatever had been
provided. Many of these deficiencies were supplied by
contemporary anatomists, nearly all of whom were Italians.
First and foremost among this secondary but yet very
important group of laborers in the field of original

348 GROWTH OF MEDICINE

research work, the names of Fallopius and Eustachius
deserve to be mentioned.

Gabriele Fallopius, who was born in Modena in 1523,
was appointed to the Chair of Anatomy at Ferrara when
he was only twenty-four years of age. Subsequently he
taught at the University of Pisa. At the time of his death
in 1563 he was Professor of Anatomy, Surgery and Botany
at Padua. He made many important discoveries in anat-
omy, more particularly in relation to foetal osteology and
the distribution of the blood-vessels. His work in the latter
department is all the more remarkable from the fact that
it was accomplished at a time when the art of injecting
blood-vessels with some opaque material was unknown in
Italy. His name has been perpetuated in connection with
the Fallopian tube. As a man Fallopius was much liked
because of his kindly disposition and absence of conceit.
The only treatise which he published was that entitled
^^Ohservationes anatomicae,^* Venice, 1561.

Bartholomaeus Eustachius, born at San Severino, in the
Marches of Ancona, in the early part of the sixteenth
century, was one of the most distinguished physicians of
his day. He taught anatomy at the famous University of
Sapienza at Rome, and devoted a great deal of time and
thought to the preparation of a large work which was
to bear the title ''On the Dissensions and Controversies
Relating to Anatomy"; but death overtook him before he
had completed this undertaking. It appears, however, that
in 1564^that is, ten years before he died — he published a
smaller work containing separate chapters on the kidneys,
the organ of hearing, the movements of the head, the vena
azygos, the vena profunda of the arm, and on certain
questions relating to osteology; and he introduced, as
illustrations for the text, eight plates of octavo size. These
plates and thirty-eight others, which were to have served
as illustrations for the great work, were all completed as
early as during the year 1552. The artist Pini, who made
the drawings that served as the originals from which the
plates were made, was related in some degree to Eustachius,
and upon the latter 's death the metal plates became his

HUMAN ANATOMY AND PHYSIOLOGY 349

property by inheritance. But nothing further was heard
of them until they were discovered, early in the eighteenth
century, by Lancisi, the Pope's attending physician, in the
possession of Pini's descendants. They were published
for the first time in 1714. Haeser says that these pictures
are true to nature, but that in artistic merit they are not
equal to those which belong to the treatise published by
Vesalius. The name Eustachius is permanently connected
with the channel which leads from the tympanum to the
nasal cavities — the Eustachian tube.

Only the briefest possible mention may here be made
of those anatomists who, following immediately in the foot-
steps of the three great leaders mentioned above, played
parts of greater or less importance in building up the
science of anatomy. Each one of them did creditable work
in correcting the errors made by their predecessors or in
supplying descriptions of structures or structural relations
which these pioneers had overlooked. Thus, long before
the sixteenth century came to an end, the gross anatomy
of the human being had attained a large measure of the
completeness which it possesses to-day. The names of
some of the more prominent men among those to whom
I have just referred are the following: Giovanni Filippo
Ingrassia, Matthaeus Realdus Columbus, Julius Caesar
Arantius, Constantius Varolius, Volcher Koyter and
Hieronymus Fabricius ab Acquapendente.

Ingrassia (1510-1580), a Sicilian physician, cultivated
osteology assiduously, and is entitled to special credit for
having first described the stapes, the third one of the
ossicles of hearing, and for having made valuable contri-
butions to our knowledge of epidemic diseases. He was a
professor in the University of Naples, and, after the year
1563, held the position of Archiater in Palermo, Sicily.
His descriptions of the diiferent bones of the skeleton were
made with such care and thoroughness that later anatomists
found very little for them to discover or to alter.

Matthaeus Realdus Columbus (or simply Realdus
Columbus), who died in 1559, was born in Cremona,
Northern Italy. He served for some time as Prosector

350 GROWTH OF MEDICINE

to Vesalius at Padua, and then succeeded him in the Chair
of Anatomy, first at Padua and afterward at Pisa. The
last teaching position which he held was that of Professor
of Anatomy in Rome, in which city he counted Michael
Angelo among his intimate friends. The discoveries which
he made in anatomy were quite numerous and of consider-
able importance, and his descriptions were distinguished
by an unusual degree of accuracy and clearness. Unfortu-
nately, he did not hesitate, at the same time, to exalt the
value of his own work by disparaging that of his famous
teacher.

Arantius, who also was one of the pupils of Vesalius,
occupied the Chair of Anatomy in his native city of Bologna
during the latter half of the century. His death occurred
in 1589. The particular department in which he gained
considerable fame was that of the foetus, the placenta, the
uterus, etc. His descriptions of these structures are
written with very great care. Blumenbach gives him credit
for having been the first anatomist to furnish a description
of the pregnant uterus in its different stages. His earliest
published work bears the title ^^De humano foetu opus-
culum,'^ Rome, 1564.

Constantinus Varolius, whose name is imperishably
connected with that part of the brain which is known as
the "Pons Varolii," was born in Bologna in 1543. He was
appointed Professor of Anatomy in the Academy of his
native city at an early age, and soon distinguished himself
by the careful studies which he made of the human brain
and nervous system in general. Before his untimely death
at the age of thirty-two he was chosen the attending
physician of Pope Gregory the Thirteenth. His earliest
published work bears the title *'Z)e nervis opticis, etc.,
epistola," Padua, 1573.

Volcher Koyter, who was born at Groningen, North
Holland, in 1534, studied under Fallopius and Guillaume
Rondelet (1507-1566), to whom the University of Mont-
pellier was indebted for its anatomical theatre, and to
whom (rather than to Gaspard Bauhin of Basel) is due
the honor of discovering the ileo-caecal valve. Koyter was

HUMAN ANATOMY AND PHYSIOLOGY 351

one of the earliest workers in the field of comparative
anatomy — a department of knowledge to which Vesalius
had already made some creditable additions ; and his two
most important published treatises bear these titles:
'*Z)e ossibus et cartilaginihus corporis Jiumani tabulae^*
(Bologna, 1566), and ^^Externarum et internarum princi-
palium humani corporis partium tabulae^ ^ (Nuremberg,
1573). He died in 1600.

Hieronymus Fabricius was born in 1537 at Acquapen-
dente, a small city of Etruria, about fifty miles northwest
of Rome. He studied anatomy at Padua under Fallopius,
and, after the latter 's death, was assigned to the duty
of making the necessary dissections and anatomical demon-
strations before the class. In 1565 he was appointed
Professor of Surgery, with the understanding that he was
to continue giving his demonstrations in anatomy. The
salary which he received for this double work was 100
ducats, but it was increased from time to time until finally
he was paid 1100 ducats yearly. At the end of thirty-six
years he was retired upon a pension of 1000 ducats for the
remainder of his life, and was allowed the privilege of
appointing his successor in the Chair of Surgery. He gave
the place to Julius Casserius in 1609. To distinguish
him from another Fabricius, who gained great distinction
in the field of surgery, it has always been customary for
later historical writers to speak of him as ** Fabricius ab
Acquapendente. " His namesake is known as ''Fabricius
Hildanus. ' '

As a teacher of anatomy, especially in its relations to
physiology, Fabricius was held in the highest esteem.
Albert von Haller speaks of him as being one of the glories
of the Italian school of medicine. Pupils came in flocks
from all parts of Europe to attend his lectures, and among
them were some who, like William Harvey of England,
afterward attained great celebrity for the effective work
which they did in advancing the science of medicine. One
of the attractive features of Fabricius' teaching was to be
found in his practice — something quite new at that period —
of showing to the students, not only the particular organ

352 GROWTH OF MEDICINE

(human) upon which he happened then to be lecturing, but
also the corresponding organ in one or several of the
animals ; thus enabling them to learn what were the features
possessed in common by all the species, and what were
those in respect of which the species differed. As time
went on, the number of those who came to witness his
anatomical demonstrations increased so greatly that he
felt impelled to build, at his own expense, a new and larger
amphitheatre. But even this, in a short time, proved to
be too small, and then the Senate at Venice, which exercised
a governing control over the University of Padua, erected
(in 1593) a much larger and more complete amphitheatre,
upon the walls of which there was placed an inscription
stating that it had been built in honor of Fabricius. Among
the other distinctions which were conferred upon him at
this time he was raised to the rank of Knight of the Order
of Saint Mark and made an honorary citizen of Padua.

Fabricius ab Acquapendente added to our stock of
anatomical knowledge by his researches on the structure
of the oesophagus, stomach and intestines, the eye, ear,
larynx and foetus. One of his chief claims to distinction,
however, rests upon the fact that he wrote an elaborate
monograph on the valves of the veins. Although these
structures had been seen and described at an earlier date
by Charles Estienne, Berengarius, Vesalius, Cannani and
others (Fra Paolo Sarpi, for example), nobody had yet
offered a satisfactory explanation of their probable use
or had traced them through the venous system at large.
In 1574 Fabricius demonstrated their presence in all the
veins of the extremities.

But Fabricius ab Acquapendente was not merely a good
anatomist and physiologist; he was also a most distin-
guished surgeon and general practitioner. From far and
from near patients came to consult him about their ailments,
and he appears to have been immensely popular among all
classes of the community. His home, situated on the River
Brenta, just outside the city of Padua, was most attractive,
and it was there that he dispensed hospitality in a princely
fashion. One of his peculiarities was that in many cases

HUMAN ANATOMY AND PHYSIOLOGY 353

he was unwilling to accept a fee for his services. As a
natural result, gifts of all sorts, many of them of consid-
erable value, were showered upon him. He devoted one of
the rooms of his residence to the purposes of a cabinet or
museum, in which all those gifts which were suited to such
display might be properly exposed to view, and over the
doorway of the room he placed this inscription, ^^Lucri
neglecti lucrum/^ which I venture to render into English
by the following, '* Costly gifts representing unproductive
wealth. ' '^

Fabricius remained a bachelor all his life, and at the time
of his death (May 21, 1619, at the age of eighty- two) his
fortune, which he bequeathed to his brother's daughter,
amounted to 200,000 ducats — a very large sum in those
days.

The writings of Fabricius were published at Leipzig in
a single volume in 1687, but Johann Bohn, who edited the
collection, omitted the different prefaces which Fabricius
had written. In the Leyden edition of 1737 this defect has
been remedied.

To furnish here even a much abbreviated account of the
important discoveries made in anatomy and physiology
during the sixteenth century would call for a much larger
amount of space than can possibly be given to these two
branches of medical science. Our modern text books on
the subject of anatomy alone are, in a certain sense, cata-
logues of these very discoveries, and every physician knows
what a vast amount of space they occupy. I have already
made mention of a few of these discoveries, and, when I
come to consider the splendid work done by William Harvey
in the early part of the seventeenth century, I shall have

2 The meaning of this Latin inscription can best be appreciated by those
physicians who have, through a long period of years, practiced their profession
largely among the well-to-do classes of a metropolitan city. They alone, I
believe, would understand the significance of "lucrum neglectum" as applied
to a large proportion of the gifts which a practitioner of medicine receives
from grateful patients; and it is not at all likely that a layman who is not
familiar with this aspect of a physician's life would, under the circumstances
mentioned, have the slightest suspicion that the device quoted above could
possibly bear the meaning that I have given to it.

354 GROWTH OF MEDICINE

occasion to recapitulate briefly the more important dis-
coveries made by his predecessors in this particular field.
In this way I shall be able to supply information regarding
several of the discoveries which I am now obliged to pass
over in silence, but which, under other circumstances, would
more properly receive consideration in the present chapter.

CHAPTER XXVIII

FURTHER DETAILS CONCERNING THE ADVANCE
IN OUR KNOWLEDGE OF ANATOMY— DISSECT-
ING MADE A PART OF THE REGULAR TRAINING
OF A MEDICAL STUDENT— lATROCHEMISTS
AND lATROPHYSICISTS— THE EMPLOYMENT
OF LATIN IN LECTURING AND WRITING ON
MEDICAL TOPICS

Further Details Concerning the Advance in Our Knowl-
edge of Gross Anatomy. — In the preceding chapter I have
given some account of the efforts made during the sixteenth
century by certain physicians to lay solidly the foundations
of a gross anatomy of the human body. The time was ripe
for such a movement, and the right sort of men took charge
of it and pushed it forward to such a stage of successful
accomplishment that we physicians of to-day are able to
continue in the direction indicated, and under the impulse
communicated, by these master builders. These men, it
should be remembered, did something more than merely
to lay solid and durable foundations in the form of an
accurate anatomy, they also taught the correct methods of
procedure for the erection of the superstructure of the
science of medicine.

Up to the end of the sixteenth century almost all the work
done in anatomy was effected with the aid of the scalpel
alone, the object being to isolate and expose clearly to view
the larger tissues and organs, such as muscles, arteries,
veins, nerves, etc. In a very few instances mor^ elaborate
methods were devised, even as early as during the fifteenth

356 GROWTH OF MEDICINE

century, by men of exceptional (Ueverness. Thus, for
example, in 1490, Alexander Benedetti, Professor of
Anatomy at Padua, invented a ibethod of preserving
muscles, nerves and blood-vessels as permanent dry speci-
mens, and it is said that he sold such preparations for large
sums of money. As already stated on a previous page, the
injection of blood-vessels with certain fluids was also
employed to a very limited extent at this early period as
a means of distinguishing them more easily from the
surrounding structures ; but this practice gave place, during
the seventeenth century, to the better method of employing,
as an injecting material, a semi-fluid preparation which
became quite solid soon after it had penetrated well into
the interior of the vessels, and to which any desired opaque
color might be given. This method was invented by the
Hollander, John Swammerdam (1627-1680) and perfected
by Van Home. It was largely by the employment of this
procedure that Friedrich Ruysch of Amsterdam (1638-
1731), Professor of Anatomy and Botany in the university
of his native city, gained such celebrity throughout Europe
for the great beauty of his permanent anatomical prepara-
tions. Hyrtl mentions the fact that Peter the Great of
Russia, who resided for a certain length of time at Zaandam,
near Amsterdam, in order that he might familiarize himself
with the art of ship-building, was in the habit of visiting
Ruysch from time to time in his museum and laboratory;
and finally (in 1717) bought from him, for the sum of 30,000
florins, his entire collection of specimens, together with the
formula of the mixture which he employed in making his
injections. The collection itself, it should be stated, con-
tained not only specimens illustrative of normal human
anatomy {e.g., the various solid and hollow organs, the
organs of special sense, and objects belonging to the
vascular, muscular, nervous and osseous systems), but
also many specimens illustrating pathological and com-
parative anatomy, and a great variety of monstrosities.

Ruysch also attained remarkable success in restoring the
rosy color and soft flexibility of the skin and the natural
facial expression in certain dead bodies by the employment

ADVANCE IN KNOWLEDGE OF ANATOMY 357

of a preservative fluid widely known as ^^ Liquor balsam-
icus.'*^ Tradition says that in one instance, that of a child
whose corpse had been treated in this manner by Enysch,
the face presented such a perfectly life-like appearance that
the Czar, as he passed near the object, thought he was
looking upon a sleeping child and gave it a kiss.

The aged professor lived to be ninety-three, and con-
tinued giving his lectures on anatomy almost up to the day
of his death, which resulted from accidental injuries.
When it became clear that these Avere of so serious a nature
that he could not possibly recover, he asked to be carried
on a stretcher into the assembly room in order that he
might say a farewell to the students who had been attending
his lectures.

Although some critics have intimated that Ruysch should
be ranked merely as a very clever mechanic in the domain
of anatomy, there are certain well-established facts which
show that this estimate of the man is unfair. It is known,
for example, that he was the first anatomist to call attention
to the features which distinguish the male from the female
skeleton {e.g., the differences in the form of the pelvis and
of the thorax). Ruysch also advanced our knowledge of
the vascular system by means of the improvements which
he effected in the method of injecting blood-vessels. His
skill in this special work was so great that people were
wont to say of him that he possessed the fingers of a fairy
and the eyes of a lynx. It was Ruysch too who furnished
the first descriptions of the bronchial blood-vessels and of
the vascular plexuses of the heart. Finally, the term
'^memhrana Rupschiana,^' in connection with the choroid
of the eye, bears testimony to the fact that he was also an
original worker in this very difficult corner of the field
of human anatomy.

The crowning event in the life of Ruysch — an event which
shows how wasteful many of us men are of our productive
powers when we deliberately retire from all participation
in active work, physical or mental, at the comparatively
early age of sixty-five — occurred in 1717, when he had
attained the age of seventy-nine. Peter the Great had

358 GROWTH OF MEDICINE

hardly left the premises with the great collection of speci-
mens for which he had paid such a fabulous price, when
Ruysch began the making of a new collection; and at this
task he worked so diligently that in less than ten years he
was able to deliver to John Sobieski, King of Poland, the
greater part of the new collection (for which he received
the sum of 20,000 florins). Then followed a period of
about three years during which he continued active work
as a teacher of anatomy, death alone seeming to possess
the power to arrest his extraordinary energy.

Euysch's only published works are the following:
Catalogue of the Specimens contained in his Museum,
Amsterdam, 1691; and a Thesaurus Anatomicus, in 10
volumes, Amsterdam, 1701-1715.

In reading over the account which I have given of the
discoveries made in gross anatomy and in physiology
during the sixteenth and seventeenth centuries, I find that
I have omitted some that may just as appropriately be
mentioned in this section as in that which I intend to
devote to work done in the domain of minute anatomy.
I shall therefore refer to them briefly now, and then pass
on to the consideration of the latter branch of my subject.

Eustachius, the famous Italian anatomist, deserves
special credit for the experimental methods which he
devised and employed in his efforts to gain a better knowl-
edge of the anatomy and physiology of the kidneys.
Moritz Hofmann of Fiirstenwald discovered in 1641, in the
turkey gobbler, the outlet duct of the pancreas, and a short
time afterward George Wjrsung, a Bavarian, discovered
the same structure in the human being. Then, in 1651,
Olaus Eudbeck, Professor of Anatomy in the University
of Upsala, Sweden, discovered the lymphatics of the
intestines, and established (at a later date) the fact that
they are a separate system from that of the chyle ducts.
Francis Glisson (1597-1677) of Cambridge University,
England, one of Harvey's pupils, made two series of
anatomical investigations of a most creditable character —
the first concerning the relationship which exists between
the intestinal lymphatics and the alimentary canal, and the

ADVANCE IN KNOWLEDGE OF ANATOMY 359

second regarding the internal construction of the liver
('' capsule of Glisson"). Thomas Wharton (1610-1673), a
native of Yorkshire, England, and a London practitioner
of medicine, discovered the outlet channel of the sub-
maxillary salivary gland, now known as ** Wharton's
duct," and he also published the first exhaustive treatise
on the structure of glands in general (thymus, pancreas,
submaxillary, etc.)- About the middle of the seventeenth
century Nathanael Highmore of Oxford, England (1613-
1685), discovered and adequately described the cavity in
the superior maxilla which bears his name (** antrum of
Highmore"), and which in comparatively recent years has
assumed such importance from the viewpoint of the
practical surgeon. A Danish anatomist, who is known to
us English-speaking physicians as Nicholas Steno (1638-
1686), but to his own coWtrymen as Niels Stensen, dis-
covered the outlet duct of the parotid gland C Steno 's
duct"). Stephen Blancaard (1650-1702), a practicing
physician of Amsterdam, made the first successful injec-
tions of capillary blood-vessels; and Domenico de Mar-
chettis (1626-1688), Professor in the University of Padua,
employing Blancaard 's technique, succeeded in proving
that the finest ramifications of both veins and arteries
communicate the one with the other. To Conrad Victor
Schneider, a professor at the University of Wittenberg,
Germany (1614-1680), we are indebted for putting an end
forever to the erroneous doctrine that the nasal mucus
is produced in the brain. He did not, however, have the
good fortune to discover the glands from which this mucus
actually comes; the credit for this discovery being due to
Niels Stensen. Among the host of other successful dis-
coverers in the domain of anatomy during the seventeenth
century the following men deserve at least to be mentioned
by name: Johann Conrad Peyer (1653-1712) of Schaff-
hausen, Switzerland; Johann Conrad Brunner (1653-1727),
also a native of Switzerland; Theodor Kerckring (1640-
1693) of Hamburg, Germany; Anton Nuck (1650-1692),
Professor of Anatomy at the University of Leyden, Hol-
land; Reignier de Graaf (1641-1673), a native of the

360 GROWTH OF MEDICINE

Netherlands; and Thomas Willis (1622-1675) and William
Cowper (1666-1709), both of them Englishmen.

And, finally, it may be stated that all the leading anat-
omists of the sixteenth century devoted a great deal of time
to the study of the manner in which the nerves are dis-
tributed throughout the body and to ascertaining the
arrangement of the intracranial and intraspinal nervous
structures. To give even the most superficial account of
what these men accomplished would occupy far more
space than can well be spared for this purpose. Kurt
Sprengel is my authority for saying that, of all the workers
in this particular field during the period in question,
Fallopius is entitled to receive the greatest credit for what
he accomplished.

The First Beginnings of Minute or Microscopic Anat-
omy.— The anatomy of the tissues — microscopic anatomy —
begins with Marcello Malpighi (1628-1694), a native of
Crevalcuore, near Bologna, Italy. It is not positively
known who was the inventor of the compound microscope.
First employed about the year 1620, the instruments of this
type came into fairly general use toward the middle of the
seventeenth century. But the early compound microscopes
were not very satisfactory, and consequently preference
was given, for a long time, to those of the simple type.
Achromatic instruments were not purchasable until 1780,
when the famous German physicist, Leonhard Euler,
succeeded in overcoming the obstacles which had up to that
time stood in the way of their successful manufacture.

In 1661 Malpighi, who was in the habit of manufacturing
his own microscopes, was able, by aid of one of these
instruments, to exhibit the blood, loaded with its corpuscular
bodies, passing rapidly from one capillary vessel to
another in the frog's lung. Then in 1683 Guillaume
Molyneux, in 1690 Anton van Leeuwenhoek, and in 1697
William Cowper, witnessed the same phenomenon in warm-
blooded animals. Among the other anatomists of this
period who contributed in varying degrees to our knowl-
edge of the minute anatomy of the different tissues and
organs the following deserve to be mentioned: J. Riolan

ADVANCE IN KNOWLEDGE OF ANATOMY 361

(1577-1657), Boselli of Naples (1608-1679), Lower of
Oxford, England (1631-1691), Vesling of Minden, Germany
(1598-1649), Regnier de Graaf of Delft, Holland (1641-
1673), who gained so great distinction by his accurate
description of the ovarian follicles (*' Graafian follicles") ;
and James Douglas (1676-1742), the English anatomist,
who ascertained and described the precise limits of the
peritoneum.

Of all the men whom I have mentioned above, Malpighi
and Leeuwenhoek are probably the best known to our
readers for the large number and important character of
the contributions which they made to microscopic anatomy.
The list of Malpighi 's achievements, for example, includes
the following, in addition to the demonstration of the blood
in actual circulation, as already mentioned: contributions
to our knowledge of the finer structure of plants; the
demonstration of the minute anatomy of the skin {^Wete
mucosum^^ or ^^rete Malpighi*^) ; the amplification of our
knowledge of the structure of the teeth ; the discovery that
the lungs are composed to a large extent of terminal
vesicles, the walls of which are richly supplied with blood-
channels; the demonstration that certain glands possess
an acinous structure {i.e., an outlet channel springing from
numerous small sacs, the whole group resembling a cluster
of grapes) ; more complete details regarding the structure
of the spleen and the kidneys (''Malpighian bodies or
corpuscles") ; additions to our knowledge of the structure
of the white and the gray substances of the brain and the
demonstration that fibres from the spinal cord pass on into
the brain; the declaration that the papillae of the tongue
are organs of taste and the papillae of the skin are organs
of the sense of touch; and not a few other contributions
of greater or less importance. During his long life Anton
Leeuwenhoek (1632-1723) of Delft, Holland, made a great
many additions to microscopic anatomy, some of the more
important of which are the following: he was the first to
discover and to describe the many varieties of Infusoria
(the animalcules found in stagnant collections of water) ;
to him is also due the credit of first observing the faceted

362 GROWTH OF MEDICINE

arrangement in the eyes of insects; he made original
investigations into the origin and mode of development
of several species of the lower organisms ; he was the first
to observe the canaliculated mode of construction in bone,
and he also noted the existence of the so-called bone-
corpuscles (afterward rediscovered and more accurately
described by Purkinje) ; he discovered the striated condi-
tion of the bundles of muscular fibres, and was also the
first person to teach the doctrine that the growth of muscles
is effected by an enlargement of the primitive bundles of
fibres and not by a multiplication of these structures; he
taught further that muscle-substance consists of numberless
small spheres; he was the first to describe the crystalline
lens as a structure composed of fibres which are arranged
in layers or sheets; in association with Guillaume Moly-
neux he studied, under the microscope, the speed with
which the blood-current travels in the blood-vessels; he
made valuable observations on the nature of the sperma-
tozoa; and, finally, the very first studies in bacteriology
appear to have been made by Leeuwenhoek. As a result
of his discovery of *' round, rod-shaped, thread-like and
corkscrew-shaped bacteria" between the teeth of a human
being, the theory was set forth that probably many diseases
owe their origin to such ** little animals.'"

The same idea, as will be shown farther on, occurred to
the distinguished medical practitioner of Verona, Italy, —
viz., Fracastoro, — one hundred years earlier (1546).
Leeuwenhoek, it should here be stated, possessed a very
great advantage over his rivals in the field of minute
anatomy, for he was in the habit of using, in his investi-
gations, microscopes which he himself had made, and which
magnified from 160 to 270 diameters, whereas those utilized
by the others were capable of magnifying, at the maximum,
only 143 diameters. While a large part of the work which
he performed shows plainly that he was a skilful and
careful anatomist and endowed with good mental powers,

1 See F. Loeffler : ' ' Vorlesungen uber die geschichtliche Entwickelung der
Lehre von den Bakterien," Leipzig, 1887, Th. 1; and also p. 310 of Pusch-
mann's "Geschichte des Medieinischen Unterrichts, " Leipzig, 1889.

ADVANCE IN KNOWLEDGE OF ANATOMY 363

Leeuwenhoek nevertheless manifested certain mean traits
of character. Daremberg says that these ** consisted in his
disposition to conceal his technical methods from his
associates, and in his jealousy of others — as manifested,
for example, toward Leibnitz, who had established a similar
laboratory for research work in minute anatomy. These
traits of character showed that fundamentally he was not
a true lover of science, but rather an artisan. And yet,
with all these faults, he does not appear to have placed
an inordinately high value upon his discoveries or to have
beei^ unreasonably sure of the correctness of his conclu-
sions." The first monograph published by Leeuwenhoek
bears the date 1673. It is a study of the minute anatomy
of the bee's sting. He was the first to declare that the blood
is the nutritive fluid par excellence, and that it is to be
found in the entire series of organisms belonging to the
animal kingdom. He divided blood into two parts — the
red, or the solid portion, and the serum. The corpuscles
which float in the serum and give to the whole fluid its red
color, are called by him *' particles, " in the case of blood
from birds, reptiles and fishes, and ''globules" in that from
quadrupeds. He employed this term ** globules" because
he believed that these bodies were exactly spherical in
shape. According to Daremberg, Leeuwenhoek 's studies
cover the entire field of human histology, and his findings
are for the most part correct.

The Founding of Organizations for the Advancement of
Medical Science. — During the seventeenth century there
were formed a number of associations which had for their
object the promotion of scientific knowledge, and these
organizations contributed greatly to stimulate original
researches in anatomy and physiology and to secure
accuracy in the published results. Perhaps the most
important institution of this kind was the French Academic
des sciences, which was founded in 1666, and which deserves
the credit of having taken a very important part in the
perfecting of our knowledge of anatomy and physiology.
The Royal Society of London, founded in 1645, possesses
a splendid record of valuable work accomplished. The

/

364 GROWTH OF MEDICINE

following organizations also deserve to be honorably men-
tioned in this place: the Accademia del Lincei at Rome,
founded in 1603 ; the Academie des Curieux de la Nature,
1652 ; and the Accademia del Cimento, founded at Florence
in 1657. New universities were also founded in Germany.

During the second half of the seventeenth century there
were three French physicians who deserve credit for the
excellence of the work which they did in the departments
of anatomy and physiology, viz., Vieussens, du Verney and
Dionis.

i ■'Raymond Vieussens (1641-1716), a native of Rovergue,
was Professor of Anatomy at the University of Mont-
pellier, in Southern France. Some idea of the extraordi-
nary industry displayed by this anatomist may be gained
from the fact that he is credited with having dissected
more than five hundred bodies. His more important
published works relate to the heart, the nervous system
and the structures of the organ of hearing. Pagel speaks
of him as being entitled to the name of founder of the
pathology of diseases of the heart.

Jean Guichard du Verney (1648-1730), who held the
Chair of Anatomy in the University of Paris, gained a large
part of his fame as an anatomist from the excellence of
his investigations into the complicated structures of the
internal ear.

Pierre Dionis, who died in 1718, was Demonstrator of
Anatomy and Surgery at the Jardin du Roi in Paris during
the latter part of the seventeenth century and early part
of the eighteenth. In 1690 he published a treatise on
anatomy which remained the standard book on this subject
for a number of years. In course of time it was translated
into the Latin, English, German and Chinese languages.

Dissecting Made a Part of the Regular Training of a
Medical Student. — The opportunities for dissecting human
bodies varied greatly in different parts of Europe during
the period of which I am now treating. Vieussens, as
we have just seen, dissected no fewer than five hundred
bodies during his long professorship at Montpellier; and
Joseph Lieutaud, Professor of Anatomy at Paris, dissected

ADVANCE IN KNOWLEDGE OF ANATOMY 365

more than twelve hundred bodies during the continuance
of his connection with that institution. So far as I have
been able to learn from my examination of the literature,
the professors and their immediate oflScial assistants were
the only persons who had, up to this time, derived the
principal benefits that flow from work of this nature; the
students merely listened to the instructor's remarks upon
the objects which had previously been exposed to view by
dissection. But toward the end of the period — a little \
before or shortly after the beginning of the eighteenth
century — facilities were provided in some of the medical
schools, and before long in all of the leading ones, for the
students themselves to participate in this highly important
part of a physician 's education. The value of such training
was emphasized by the statement made by the English
philosopher, John Locke (1632-1704), toward the end o*f his
life, viz., that all human understanding is based upon
experience. He wrote that at birth the human soul is like
a clean sheet of paper upon which all the objects perceived
by the senses are recorded as experiences, and there they
remain until by the aid of reflexion — i.e., by the aid of the
understanding, which Locke calls the inner sense — they are
combined into conceptions or ideas. Locke, it should be
remembered, was educated as a physician, but he never
took his degree, nor did he ever practice medicine.

The first stimulating effects of the Renaissance upon the
devotees of the science of medicine were felt in Italy toward
the end of the fifteenth century, and these effects rapidly
gained in intensity during the following century. First
France and afterward Switzerland, Belgium, Holland and
England were almost simultaneously brought under the
same influence; and in all these countries the students
manifested a remarkable eagerness to acquire all the
knowledge they possibly could. In Germany, however, the
influence of the Renaissance did not make itself felt until
a much later date, and the thirst for knowledge was very
much slower in developing than was the case in any of the
other countries mentioned. Thus Puschmann, in his
** History of Medical Education," makes the following

366 GROWTH OF MEDICINE

statement which shows clearly that in Germany the univer-
sity students of that period must have been a very rough
set of men: ''In 1625 the Senate of the University of
Leipzig was obliged to warn its students that they must
cease disturbing wedding festivals and handling the guests
roughly, that they must no longer make obscene remarks
to married women and maidens, etc. And in 1631 a physi-
cian named Lotichius, in writing to a friend, made the
statement that 'in our German high schools the students
seem to prefer strife to the reading of books, daggers to
copy-books, swords to pens, bloody encounters to learned
discussions, incessant boozing and noisy reveling to the
quiet pursuit of their studies, and public-houses and
brothels to students' work-rooms and libraries.' " In
1660 the students at Jena, on one occasion, carried on a
regular battle with the police, and as a result of this
encounter several persons were killed. In the light of this
evidence, therefore, it is not surprising that the science
of medicine made comparatively little advance in Germany
until after the eighteenth century was reached.

latrochemists and latrophysicists. — During the seven-
teenth century there was a great deal of disputing among
physiologists about the nature of certain processes like
assimilation and retrograde metamorphosis, about the
manner in which blood is formed, about digestion, and about
the role played by the lymph vessels. According to Haeser
a large proportion of the physicians of that day were
confident that chemistry was entirely competent to solve
these riddles, and yet, on the other hand, there were not a
few who believed that the science of physics, which was
then much further advanced than that of chemistry, was
quite as competent to explain all the phenomena. At first
the split into these two factions was confined to men who
were interested in questions of a purely physiological
nature, but in a short time the practitioners of medicine
were also drawn into the controversy; and from that
time onward it became customary to employ the terms,
" latrochemists" and "latrophysicists" in speaking of the
partisans of the two schools of medicine (the iatrochemical

ADVANCE IN KNOWLEDGE OF ANATOMY 367

and the iatrophysical or iatromeclianical). The iatro-
chemists described digestion as an act that is essentially
chemical in character, a form of fermentation; and by the
latter term the more advanced members of this school —
Francois Deleboe Sylvius (1614-1672), who was born in
Hanau, Prussia, of Dutch parents, and who took his
doctor's degree in Basel in 1637, and Thomas Willis of
London (1622-1675) — understood something quite different
from our modern conception of fermentation. Their inter-
pretation was as follows : ' ' An internal chemical movement
of nlatter which is set agoing and continued in action in the
stomach and intestinal canal through the agency of certain
chemical reagents. " (Haeser.) They attributed an impor-
tant influence to the salivaT, the pancreatic juice and the
bile in effecting the changes mentioned. The iatro-
physicists, on the other hand, and more particularly
Archibald Pitcairn of Edinburgh, Scotland (1652-1713),
and Giorgio Baglivi of Eagusa, Italy (1668-1707), described
digestion as a purely mechanical breaking up of the ele-
ments of the food partaken — a ''trituration." As to the
further fate of the resulting chyle (its mode of reaching
the blood, for example) the two schools were in perfect
accord.

Sprengel mentions it as an actual fact that, during the
seventeenth century, there were several physicians who
combined the two careers of teacher of medicine and
hydraulic engineer (iatrophysicists or iatromathemati-
cians).^ Several events conduced to the formation, in
Italy and in Great Britain, of a distinct iatromathematical
school. Among them may be mentioned, first and foremost,
Harvey's discovery of the circulation of the blood; second,
the spread of the doctrines taught by Descartes favored
in a marked degree the union of medicine and mathematics
(physiology, the iatromathematicians claimed, was only a
branch of applied mathematics) ; and, third, the formation
at Florence, in the middle of the seventeenth century, of
an association of the pupils of Galileo. The objects of this

2 The iatrophysicists and the iatromathematicians constituted apparently
two kindred branches of the same school.

368 GROWTH OF MEDICINE

association were to cultivate their master's philosophy,
to carry on the work of experimental physics, and to apply
its principles in every department of natural science.
Alphonso Borelli (1608-1679), Professor of Mathematics
first at Messina and afterward at Pisa, the author of the
famous treatise on ' ' The Movements of Animals, ' ' and the
founder of the iatromathematical school, was a member
of the association. In this connection it is important to
mention another zealous worker in the field of iatro-
mathematics, viz., Sanctorius Sanctorinus, of Capo d'Istria
(1561-1636). His work was done quite independently
of any general movement among scientific investigators
and at a much earlier period than that during which the
school flourished. He was quite successful, for example,
in his attempts to measure the actual amount of impercep-
tible evaporation, and to determine the influence which this
process exerts upon health and disease. In the course of
these investigations in what he called ''static medicine,"
Sanctorinus invented a number of unusual instruments.

The phenomenon of the formation of schools or sects,
the members of which were keenly interested in the mainte-
nance and promulgation of certain physiological, patho-
logical, or therapeutic doctrines, manifested itself anew,
as I have shown above, in the seventeenth century. In
the early years of the Christian era the partisans of
different medical doctrines formed schools of this nature
which flourished for a certain period of time and then died
out completely. Such, for example, were the sects of the
Dogmatists, the Methodists, the Pneumatists, etc. The
mere fact of the existence of these different schools or sects
showed unmistakably that the science of medicine was alive
at that time and that its devotees were making vigorous
efforts to increase their stock of knowledge. Then followed
the long period of the Middle Ages, a series of many cen-
turies, during which medicine made only slight gains ; but
at last came the Renaissance, — the fifteenth, sixteenth and
seventeenth centuries, — and here again we have a recur-
rence of the same phenomenon of sects in medicine; but
note the great difference between the earlier manifestations

ADVANCE IN KNOWLEDGE OF ANATOMY 369

-and those which I have just outlined. The present group,
it is proper to remark, is merely the forerunner of several
similar movements that are to occur during the eighteenth
and nineteenth centuries, movements that are all based, in
varying degrees, upon the truth.

The Employment of Latin in Lecturing and Writing on
Medical Topics.— Ija-^ the countries of Europe, but more
particularly in..6^many, there existed during the sixteenth
and sevenWnth centuries — and for a long time subse-
quently—t;he practice of delivering all the lectures on
medicajktopics in the Latin tongue — i.e., in a language
whi^lkat best could not be easily understood by more than
a small proportion of the students. Even the lecturers
themselves must have been hampered in the full expression
of their thoughts by this rule, which was practically
compulsory. Paracelsus (1493-1534), the famous Swiss
physician, tried — a full century earlier, as will be shown
farther on — to break up this seemingly harmless but in
reality objectionable custom; his example, however, was
not followed, and the practice was continued without
interruption for at least two centuries longer. The use
of Latin as the language in which all medical knowledge
was to be taught was undoubtedly based upon the idea that
it was necessary for the educated physician to be reason-
ably familiar with that particular tongue, for the simple
reason that it was the only one in which, in those early days
in "Western Europe, the writings of Galen were accessible,
for nobody but a few expert scholars had yet acquired any
useful knowledge of Greek, the language in which all of
Galen's works were originally written. But it is quite
likely that with this motive, which certainly was intended
to produce good and useful fruit, there was coupled the
further idea that the great mass of irregular practitioners —
the quacks, the early barber-surgeons (Wundaerzte), and
the peripatetic physicians — would in this way be debarred
from entering the ranks of the regularly trained physicians.
It was only after the custom of using the Latin for
lecturing and writing purposes had become thoroughly
rooted in the minds of medical men as something right and

370 GROWTH OF MEDICINE

proper, that it began to dawn upon the minds of some of
the brighter men that this practice was harmful to the
advance of medicine beyond the standards established by-
Galen. Vesalius, who was a contemporary of Paracelsus,
fully appreciated how serious an obstacle to further
progress in anatomical knowledge the teachings of Galen
were, and it was he who made the first really successful
attack on this great hindrance to further progress; but
there is no evidence to show that he had the slightest idea
that lecturing and writing about medical topics in Latin
played any part in the perpetuation of the evil which he
was fighting. To Paracelsus alone belongs the credit, so
far as I know, of endeavoring, through the force of example
and by spoken arguments, to break up the practice which
we are here considering. I may be mistaken in the view
which I have here expressed, but it is difficult for me not
to believe that the habitual use of Latin as the proper
vehicle for the transmission of facts and ideas belonging
to the domain of medicine must have materially hindered
the advancement of that science; for such use certainly
tended to keep men's minds moving in fixed ruts, and those
ruts all led straight toward the faulty teachings of Galen.

CHAPTER XXIX

THE CONTEIBUTIONS MADE BY DIFFERENT MEN
DURING THE RENAISSANCE, AND MORE PAR-
TICULARLY BY WILLIAM HARVEY OF ENG-
LAND, TO OUR KNOWLEDGE OF THE CIRCULA-
TION OF THE BLOOD, LYMPH AND CHYLE

Among the earliest known doctrines relating to the
nature of the blood and its mode of distribution throughout
the body are those attributed to Erasistratus and Galen;
for the still more ancient ones, of which Diogenes of
ApoUonia, Aristotle and the Hippocratic writers are
reputed to be the authors, are too incomplete to call for
serious consideration in this place.

(a) The Doctrine Taught by Erasistratus. — Erasis-
tratus, who was born at Julis in the Island of Ceos (Aegean
Sea) during the third century before Christ, held the belief
that the arteries contain only air, which is drawn into the
lungs by way of the trachea and bronchi, whence it enters
the pulmonary vein (called by him the ** venous artery").
In its further course this air passes from the pulmonary
vein into the left ventricle of the heart, and is then conveyed
from that organ through the arteries to the different tissues
of the body. Erasistratus further taught that the smallest
subdivisions of both the arteries and the veins lie side by
side in the tissues, and that, in certain abnormal bodily
conditions, they communicate the one with the other
through anastomoses; but that, in a normal condition of
the body, no communication takes place between the two.
In common with all other physicians of that time, he
believed that only the veins carry blood. Here, then, we

372 GROWTH OF MEDICINE

find the first glimmering of the truth with regard to the
nature of the circulating medium and also with regard to
the course which it pursues in one part of its circuit — that
part, namely, where the two kinds of vessels become
capillary in character. His substitution of air for blood
in the arteries is plainly the principal error in his scheme.

(6) The Teaching of Galen and of Caesalpinus with
Regard to the Nature of the Blood and Its Mode of Dis-
tribution.— Galen, in the second century of the present era,
disputed the correctness of the doctrine taught by Erasis-
tratus. His objections are thus stated: ''Inasmuch as
blood flows from an artery when it is wounded, one of two
things must be the truth. Either blood was already con-
tained in the vessel before it was wounded, or it must have
found its way in from the outside. But, if the blood comes
from the outside into a vessel which contains only air, then
air must necessarily escape from that vessel (when
wounded) before blood does — which is contrary to the fact,
as blood alone flows out. Therefore arteries contain only
blood." As a further proof of the correctness of his
statement Galen carried out the following experiment:
In a living animal he placed two ligatures around an artery
at points situated not far apart, and then made an opening
in the vessel between the two ligatures. The intervening
section of the artery, it was thus found, contained only
blood. This experiment, it might reasonably be supposed,
would have definitely settled the question; but such was
not the case. The followers of Erasistratus immediately
raised this objection: If the arteries contain blood, how
may the air which is drawn into the lungs find its way to
all parts of the body? Galen replied that the inhaled air
does not pass through the lungs, but is rejected by them
after it has cooled the blood. This refrigerating process,
he claimed, constitutes the sole purpose of the respiratory
act.

Although Galen's idea regarding the true function of
respiration is not in harmony with the doctrine taught by
modern physiologists, it nevertheless represents a marked
advance over the belief previously maintained. Even as

CIRCULATION OF TEE BLOOD 373

recently as in the time of Albert von Haller (approximately
1760-1780) physicians still continued to believe that it was
the function of respiration to cool the blood; and indeed
it was scarcely possible before 1800 to offer a more correct
physiology of the act of breathing, for it was not until
after the lapse of many centuries that the advance in our
knowledge of chemistry reached a point at which it became
possible to find a satisfactory solution of so complicated
a problem.
V As to the nature of the blood itself Galen believed, as I
have already stated more fully in Part I. (*' Ancient
Medicine"), that there are two kinds — spirituous blood
(or /spirit) and venous blood. He gave the name of
spirituous blood to that which is found circulating in the
arteries, and which is appreciably brighter in color than
that which fills the veins. According to Flourens, the
distinguished French physiologist of the nineteenth cen-
tury, Galen was the first among the ancient anatomists to
make this distinction of two different kinds of blood. To
the spirituous variety Galen ascribed the function of
nourishing the more delicately constructed organs like the
lungs, while he claimed that the venous blood is suited to
nourish only the coarser ones, like the liver, spleen, etc.

In his further development of a physiology of the
circulation of the blood Galen, who as a rule expresses his
ideas with great clearness, makes statements which I find
it extremely difficult to comprehend. I am therefore
tempted to assume that the copyists, to whom we are
indebted for handing down his actual words from age to
age, are the persons upon whom should be cast the blame
for the obscurity of which I complain. However this may
be, it is an unquestionable fact that the ablest physiologists,
were they to be confronted to-day with the duty of solving
this problem of the circulation under the conditions of
knowledge which existed during the third century of our
era, would surely not be able to provide a more correct
solution than that which is credited to Galen. The problem
was attacked repeatedly by some of the brightest and best-
equipped minds of the Renaissance period, but not one of

374 GROWTH OF MEDICINE

these exceptionally clever men was able to offer an entirely-
acceptable solution. Harvey alone, as will appear farther
on in this account, solved the riddle once and for all.

The ^'spirit" — the purest part of the blood — is lodged,
according to Galen, in the left ventricle ; and, inasmuch as
even the venous blood, if it is to fulfil in some degree the
function of a nourishing fluid, must possess a certain
proportion of ** spirit," it is clear that the two ventricles
should communicate the one with the other ; for how other-
wise— thought Galen — is it possible for a certain amount
of ** spirit" to commingle with the venous blood? The
locality at which this communication was assumed to exist
was the interventricular septum; and, as nobody was able
to find anything like a foramen in this membrane, it was
asserted that the communication is effected through an
infinite number of pores. For over one thousand years
physicians accepted this porous character of the inter-
ventricular septum as an established fact. In his com-
mentaries on Mondino's ''Anatomy" (1521), Berengarius
of Carpi timidly ventured the statement that the openings
of communication are not distinctly visible, and this appar-
ently was the first feeble expression of doubt concerning
the correctness of the prevailing doctrine. Vesalius, on
the other hand, boldly denied their existence altogether.

According to Galen's teaching the liver is the source
of origin of all the veins, just as the heart is the starting-
point of all the arteries. It is quite remarkable, says
Flourens, that physicians who performed almost daily the
operation of venesection should, during a long series of
years, have failed to observe that this doctrine of blood
flowing through the veins from the liver to the different
parts of the body, could not possibly be true, inasmuch as
at each such operation the vein always became distended
with blood below {i.e., on the distal side of) the ligature
which they applied to the part (arm, for example) before
opening the vessel. This phenomenon, of course, indicated
clearly that the blood in the veins flowed toward the heart,
and not from any centrally located spot or organ toward
the extremities. And yet — he adds — even so bright and

CIRCULATION OF TEE BLOOD 375

thoughtful a man as Vesalius does not appear to have
noticed this fact. Andreas Caesalpinus (1519-1603), on
the other hand, did observe and correctly interpret the
phenomenon; and he made the further observation that
physicians were habitually applying the ligature above the
spot which they expected to bleed, regardless of the fact
that in so doing they were not acting in harmony with their
belief concerning the circulation of blood in the veins.
Caesalpinus also states, in one part of his writings, that
''the blood, carried to the heart by the veins, receives in
that organ its last transformation toward perfection,
and is then — in this perfected state — transported by the
arteries to the remotest parts of the body." So far as it
relates to the general movement of the blood this statement
is correct, but it errs, as will be shown presently, in men-
tioning the heart as the locality where the perfecting
process takes place. In his final remarks regarding the
anatomical relations which exist in the two chambers of
the heart Caesalpinus makes the following statement: —

Each ventricle possesses two vessels — one through which the
blood reaches that chamber, and a second one which serves to carry
it out of the ventricle. The vessel through which the blood enters
the right ventricle is called the vena cava, and that by which it
leaves this same chamber is called the pulmonary artery. The
vessel through which the blood arrives in the left ventricle is called
the pulmonary vein, and that through which it leaves this left
chamber of the heart is known as the aorta.

The Circulation of the Blood as Elucidated hy Michael
Servetus. — Michael Servetus, a native of Villanueva, Spain,
who in 1553 was burned alive at the stake near the city of
Geneva, Switzerland, because of his heretical teachings, is
not infrequently mentioned as the individual to whom credit
is due for having furnished the first description of the
lesser or pulmonary circulation. There is no question
whatever regarding the justice of according to him at
least a part of this honor, but one should be careful to
specify that Servetus is entitled only to the credit of having
been the first to teach that the blood, in its journey from

376 GROWTH OF MEDICINE

the right to the left side of the heart, must pass entirely-
through the lungs. So far, his doctrine is correct; but
he also taught at the same time that the fluid which enters
the aorta from the left ventricle is not blood but perfected
''vital spirit" (Galen), and that it becomes genuine blood
only after it has tarried for a few brief instants in the
ventricular chamber and has there been subjected to some
unknown influence exerted by the heart itself. This second
erroneous part of Servetus' description seems to me to
diminish very materially the credit to which he is otherwise
entitled ; and I cannot help feeling that Dezeimeris is right
when he claims that Realdus Columbus, whose more perfect
account of the lesser circulation was written only a little
later than that of Servetus, is perhaps better entitled to
the honor in question.

It is an interesting fact that Servetus introduces his
disquisition on the circulation of the blood in the very midst
of a treatise which bears the title ''Restitution of Chris-
tianity, ' ' — in other words, in a treatise which would never,
under ordinary circumstances, be consulted by physicians
in their search for information regarding an important
problem in physiology like that of the circulation of the
blood. In this physiologico-theological treatise Servetus,
who — as I omitted to state — was a theologian as well as a
physiologist, used the following expressions : —

The soul, says Holy Writ, is in the blood; as a matter of fact,
the soul is the blood. And since the soul is in the blood, one
should — if one wishes to learn how the soul is formed — endeavor
to learn how the blood is formed; and, in order to learn how the
blood is formed, it is necessary to ascertain how it moves,
(Flourens.)

I am unable to state whether it was this particular
chapter, or the work taken as a whole, which appeared to
the ecclesiastical authorities — first those of France and
afterward those of Geneva — to warrant the author's
condemnation as a heretic. And, when we are disposed to
blame severely those bigots who, in the fifteenth and six-
teenth centuries, manifested such a keen desire to destroy

CIRCULATION OF THE BLOOD 377

** heretics," let us remember, with a proper sense of shame,
that we still have in our midst, in this twentieth century
and in this ' ' land of freedom, ' ' men of high social standing
who are as virulent heresy-hunters as ever were the enemies
of Servetus.

Experiments of Realdus Columbus. — Matthaeus Kealdus
Columbus, who was born at Cremona, Northern Italy, in
the early part of the sixteenth century, acted for some time
as Vesalius ' prosector, and must therefore have had ample
opportiinities for acquiring a thorough knowledge of the
experimental method of studying questions in physiolog)^
He wrote a description of the pulmonary circulation which
was more lucid and nearer to the truth than any which his
predecessors had furnished. This description, which will
be found in his treatise on anatomy (Venice, 1559), was
based largely upon experiments that he carried out upon
living dogs. As rendered into English from the French
version supplied by Dezeimeris, it reads as follows: —

When the heart dilates the blood passes from the vena cava into
the right ventricle; from the latter chamber it is pushed into the
arterial vein (the pulmonary artery), along which channel it is
carried to the lung, there to be properly thinned and mixed with
air. Ultimately the blood passes on into the venous artery (= the
pulmonary vein), the function of which vessel is to carry this fluid,
now charged with air through the action of the lung, into the left
ventricle of the heart. Then follows the contraction (systole) of
this organ, as a result of which action the tricuspid valves rise up
into position and form a dam that prevents the return of the blood
into the vena cava and the pulmonary veins. Simultaneously with
this action the valves placed at the opening which represents the
commencement of the aorta (left ventricle), and those placed at
the opening which corresponds to the beginning of the pulmonary
artery (right ventricle), yield and thus open the way for the
distribution of the blood throughout the rest of the body.

The reader will, I believe, admit that this description,
while perhaps not faultless, is distinctly superior to that
given by Servetus.

Columbus ' experimental studies threw considerable light
upon other matters relating to the physiology of the heart.

378 GROWTH OF MEDICINE

He demonstrated, for example, that the fluid which enters
the left ventricle from the lungs is genuine blood, and he
also learned by the same method of investigation the true
nature of the systole and diastole of the heart and the
relations of these acts to the pulse and to the changes in
the position of the heart. The discovery of all these facts
constituted a material advance in our knowledge of the
physiology of that organ; but, from this time onward, for
a period of nearly three-quarters of a century, no further
advance was made until William Harvey of England
appeared on the scene. The explanation of the failure of
such able investigators as Realdus Columbus, Vesalius,
Servetus and others to push their researches still further
is to be found largely in the fact that they were all still
in bondage to the doctrines taught by Galen centuries
earlier, and probably more particularly to that dogma which
maintains that blood — ^if it is to be accepted as genuine or
fully formed blood — must first have been elaborated in the
depths of the liver. The impossibility of harmonizing such
a dogma with the facts which by that time were well
established, is too plainly evident to warrant further
discussion in these pages.

Discovery of Valves in the Larger Veins hy Fahricius
ah Acquapendente. — The discovery of the presence of
valves in the interior of the larger veins is credited by some
to Cannani (1546) and by others to Fabricius ab Acqua-
pendente (1574), but the best authorities appear to favor
the claim of Fabricius to this honor. There are also a few
authorities who maintain that Fra Sarpi, the celebrated
monk and scientist of Venice, is entitled to be considered
the discoverer of the valves in veins, but Tiraboschi, the
historian of Italian literature, makes it clear that this
claim is unfounded.

Although it was known to Fabricius that these valves are
inclined toward the heart, he does not appear to have
appreciated the fact that this arrangement is entirely
incompatible with Galen's doctrine that the flow of venous
blood is from the liver toward the extremities ; nor did any
other anatomist, so far as I am able to learn, discover this

CIRCULATION OF TEE BLOOD 379

incompatibility before it was pointed out by Harvey nearly
fifty years later.

William Harvey, Who is Universally Acknowledged to
he the Real Discoverer of the Circulation of the Blood. —
William Harvey was born at Folkstone, England, in 1578,
received his academic education at Cains College, Cam-
bridge, and became a doctor of medicine in 1602, at the age
of twenty-four. Four or five years before this event he
went to ^ Padua, Italy, to study medicine under Fabricius
ab Acquapendente, who was considered at that period to
be the ablest and most inspiring teacher of anatomy and
physiology in Europe. It was from him, it may safely be
assumed, that Harvey learned the importance of studying
Nature herself, rather than books, when one is desirous of
learning her secrets. Equipped with a thorough knowledge
of the methods that may best be employed in making studies
of this character, Harvey returned to England at the end
of his long stay at Padua. He was soon afterward made
a member of the College of Physicians of London, and in
1615 was elected to the Chair of Anatomy and Surgery in
that institution. Later still, he was appointed one of the
physicians of St. Bartholomew's Hospital. He also held
for several years the position of Court Physician, first to
James the First and then to Charles the First. It was
during this period of his professional career that he began
working in earnest upon the problem of the circulation of
the blood, and he kept steadily at this work throughout a
period of several years. Among the manuscripts preserved
in the British Museum there is one bearing the date of 1616
which shows that Harvey had already at this time reached
conclusions which, in all essential respects, agree with those
which appear in his final treatise published in 1628. The
title of the latter work is, ^^Exercitatio anatomica de motu
cordis et sanguinis in animalibus^^ (Frankfort, 1628).

Although, as I have shown above, several of the links in
the chain of proofs bearing upon this question of the
circulation had already been discovered before Harvey
began his researches, he was not willing to accept them
as proven facts until he had himself tested them thor-

380 GROWTH OF MEDICINE

OTighly by the experimental method. Furthermore, they
were often disconnected, and this lack of continuity obliged
him to supply missing links at several points; in other
words, nobody had as yet demonstrated the important fact
that the blood travels regularly in an unbroken circuit, and
it was to this great task that Harvey devoted himself at
the period which we are now considering. He carried out
all these investigations with the most painstaking care and
made public announcement of his discoveries only after
the lapse of an extraordinary length of time; his chief
object being that ample opportunity might thereby be
afforded for complete verification. The following are
among the more important questions which he investigated
and to which he furnished satisfactory solutions. He
learned, for example, that the auricle and ventricle of each
side of the heart do not contract simultaneously but in
succession. When the right auricle contracts the blood
which it then contains passes into the right ventricle ; and
when the right ventricle contracts the blood is driven into
the pulmonary artery. From this vessel it passes ulti-
mately into the pulmonary vein, and from the latter into
the left auricle, which then contracts and drives the blood
into the left ventricle. The latter chamber next contracts
and forces the blood into the aorta, whence it is carried
into all the arteries of the body. From these, in turn, it
passes into the veins and thence back to the right auricle
of the heart — the point from which it started. He corrobo-
rated the finding — ^by other anatomists who had preceded
him — of membranous valves at the spots where the blood
passes from one chamber to the other; and he compared
these valves to little doors which open to permit the passage
of the blood in one direction, but which close when there
is any tendency for it to pass in the opposite direction.
The valves of the right auricle, for example, allow the
blood to pass into the right ventricle, but prevent it from
returning into the auricle. Then, further, the valves of
the right ventricle permit the blood to pass into the
pulmonary artery, but prevent it from returning into the
ventricle. The valves of the left auricle permit the blood

5arfl

FIG. 15. WILLIAM HARVEY.
(After the portrait by Cornelius Jonson.)

CIRCULATION OF TEE BLOOD 331

to pass into the left ventricle, but do not permit it to return
into the left auricle. Finally, the valves of the left ventricle
allow the blood to pass into the aorta, but prevent it from
regurgitating into the same ventricle. The valves with
which the veins are equipped permit the blood to travel
onward toward the heart, but do not permit it to back up
into the arteries.

Galen taught that the arteries pulsated by reason of a
"pulsific^ power" which they derive in direct continuity
from the tunics of the heart. He tried to prove the correct-
ness of his doctrine by experimental methods, but in this
he failed. Harvey was convinced that the arteries do not
pulsate by reason of their own inherent power, but by a
force of impulsion communicated to the blood at the heart.
He refers to this question in the following terms: ''When
an artery is opened the blood escapes in jets of unequal
force; the alternate jets being stronger than the inter-
mediate, and the stronger jets corresponding in time of
occurrence, not with the systoles but with the diastoles of
the artery. The artery, therefore, must be distended by
impulsion, by the shock of the blood. If the artery dilates
by reason of its own inherent power, the blood would not
be expelled with the maximum force at the very moment
when this dilatation occurs." As evidence of the non-
existence of Galen's assumed ''pulsific power," Harvey
mentions the fact that, in the case of a patch-shaped
calcification of the crural artery which came under his
observation, the pulsation took place as usual, but at a
point below (distal to) the edge of the patch. The inter-
vening patch of rigid calcareous matter was not able to
prevent the traveling onward of the propelling power.

Harvey next takes up the consideration of the veins, and,
after showing that they permit a flow of the contained
blood in only one direction, — ^viz., that from the extremities
toward the heart, — he calls attention to certain experiences
which he has had: (1) When a cord is tied lightly around
a limb the flow of blood is arrested only in the veins, because
these vessels are located near the surface of the skin; but,
if the cord is tied more tightly, the flow of blood is also

382 GROWTH OF MEDICINE

arrested in the arteries, which lie at a relatively great
depth. (2) When a vein is tied the resulting distension
manifests itself only below {i.e., on the distal side of) the
ligature; whereas, when an artery is similarly tied, the
distension takes place above {i.e., on the proximal side of)
the ligature. It is therefore plain that in the veins the
blood flows from the individual parts toward the heart, but
that in the arteries the flow is in the reverse direction — i.e.,
from the heart toward the individual parts. ''If one
reflects upon the nature of the movement of the blood,"
says Flourens, ''one will promptly realize how speedy it
is. Scarcely has the blood entered the heart before it is
hurried into the arteries; and then from these vessels it
passes in an instant into the veins, from which, with almost
equal speed, it finally travels back to the heart again. It
is this never-ending movement from one channel into
another, and then eventually back to the starting-point,

which constitutes the circulation of the blood

Modern physiology dates from the discovery of the circu-
lation of the blood. Up to the time of this discovery
physiologists followed the ancients; they did not dare to
walk alone. Harvey had discovered the most beautiful

phenomenon in the animal economy From this

time forward, instead of swearing by Galen and by Aris-
totle, one had to swear by Harvey ! ' '

Despite the great care which Harvey took to back up his
scheme of the circulation of the blood with unimpeachable
proofs of its correctness, he was obliged to pass through
the same sort of experience as that to which Vesalius and
scores of other pioneers in the field of scientific inquiry had
been subjected. Two hostile forces stood constantly ready,
during that fruitful period of the Eenaissance, to attack
with merciless bitterness all those who ventured to add new
facts to our stock of knowledge in the domain of medicine.
On the one side were the many men of small calibre, men
filled with jealousy over the successes gained by co-workers
in the same field ; and on the other was marshaled the host
of those who honestly believed that all medical msdom
ended with Galen. Before his death, however (hardly

CIRCULATION OF TEE BLOOD 383

thirty years later), Harvey had the satisfaction of witness-
ing the almost unanimous acceptance of his dogma con-
cerning the circulation of the blood. Louis the Fourteenth,
King of France at this period, was so appreciative of the
importance of Harvey's discoveries that he appointed
Dionis, the distinguished French anatomist, to demonstrate
to the students of the Medical School of the Jardin des
Plantes at Paris the circulation of the blood and other
recent discoveries. Descartes (1596-1650), the celebrated
French philosopher, paid an even greater compliment to
the high character of the work- accomplished by Harvey.
His words, as quoted by Flourens, are as follows : —

If I am asked why the supply of venous blood does not become
exhausted in flowing thus unceasingly into the heart, and why
the arteries — since all the blood that passes through the heart must
travel along these vessels — do not become filled to overflowing, I
can see no good reason why I should not give to this question the
very same answer that William Harvey, an English physician,
to whom praise is due for having taught , . . . , has already given.
[Then follows the text of Harvey's reply.]

Our readers have doubtless noted the fact that, while
Harvey, as I have endeavored to show in the preceding
account, has clearly established his right to be considered
the discoverer of the circulation of the blood in all its most
essential features, his scheme fails to furnish any infor-
mation concerning the composition of the blood and the
manner in which it is built up into a life-giving fluid. In
the minds of some this may seem to be an omission. A
moment's reflection, however, will satisfy any reasonable
person that questions of this nature do not form a legiti-
mate part of the problem which Harvey was engaged in
solving, and that they therefore should receive separate
consideration. Thus, for example, Harvey's scheme fails
to furnish satisfactory information concerning those por-
tions of the circuit where the blood is obliged to travel
through a system of communicating capillary channels, as
happens in the lungs and in the tissues generally through-
out the body. But Harvey had no means at his command

384 GROWTH OF MEDICINE

for investigating a question of this nature. Capillary-
blood-vessels are invisible to the naked eye, and may be
studied only with the aid of a microscope; but this
instrument was not available until long after the time
(1605-1616) when Harvey was engaged in carrying out his
investigations into the circulation of the blood.

Other Discoveries Relating to the Vascular System. — To
Vesalius is due the credit of having discovered the fact that
anastomoses exist between the carotids and the vertebral
arteries, thus explaining how a man may continue to live
even after both carotids have been severed or ligated. His
great rival, Fallopius, described these anastomoses in the
most detailed manner, and he noted the further fact that
an anastomosis with the basilar artery exists.

By the end of the sixteenth century a certain amount of
progress had been made toward a correct knowledge of the
lymphatics. Bartholomaeus Eustachius, for example, dis-
covered the existence (in horses) of the thoracic duct, but
he supposed it to be a vein. His description of this vessel
reads as follows : —

In these animals there is a large vessel which extends downward
from the inner aspect of the clavicular vein ( = left subclavian
vein). At the point where it joins the vein it is closed by means
of a semicircular valve. This vessel is of a whitish color and it
contains a scanty watery fluid. Not far from its starting-point it
divides into two branches which very soon, however, join together
again, and then, as a single trunk from which no further branches
are given off, it passes down along the left side of the spinal column,
penetrates the diaphragm, spreads itself out over the aorta, and
ends in a manner unknown to me.

About one hundred years later (1647), Jean Pecquet of
Dieppe, France, professor in the Medical School of Mont-
pellier, rediscovered (in a dog) this same duct, with its
tributary chyle ducts and also its point of entrance into
the left subclavian vein ; and, as he had rightly interpreted
its nature, anatomists by common agreement accorded him
the rights of discoverer.

CIRCULATION OF THE BLOOD 385

At a still earlier date (1622) Caspar Aselli of Cremona,
Northern Italy, professor in the Medical School of Pavia,
discovered the chyle ducts. This discovery was made under
the following circumstances, which reveal the fact that
good luck sometimes plays an important part in the work
of the searcher after truth in the departments of anatomy
and physiology: —

Aselli was studying the distributiomof the recurrent nerves and
the movements of the diaphragm in a well-nourished living dog,
when his attention was drawn to the presence of a large number
of delicate white threads coursing as it were over the surface of
the mesentery. Following the accidental injuring of one of these
threads there escaped from the wounded structure quite a large
quantity of chyle. Aselli, who instantly appreciated the full sig-
nificance of what had happened, exclaimed, in the presence of the
bystanders, ''Eureka!" At the time he supposed that these chyle
vessels terminated in the liver and contributed in some manner
to the elaboration of the blood (in harmony with Galen's univer-
sally accepted theory of sanguification) ; but later, after he had
carried out a carefully conducted series, of experiments, he was
able to rectify this erroneous belief. (Haeser.)

Galen's theory of sanguification may be stated as follows :
The chyle is received into the veins of the intestinal wall
and carried thence to the liver, in which organ they are all
gathered together into a single venous trunk which has
received the name of ^'vena portae^' — the vein of the gate-
way. Everything that is destined to enter the liver passes
through this portal vein. In the organ itself the chyle
undergoes certain modifications, the result of which is, first,
to deprive it of its impurities and then, in addition, to effect
other changes that convert it into blood. Aselli 's glory,
then, consists in his having shown that chyle is taken up
from the intestinal mucous membrane by a set of its own
vessels, and not by the veins, as taught by Galen.

In 1651 Olaus Rudbeck of Arosen, Sweden, discovered
the lymphatics of the intestinal canal and followed their
distribution into the lymph nodes ; he also established their
relations with the thoracic duct and with the venous system.

Thus, thanks to the series of brilliant discoveries made

386 GROWTH OF MEDICINE

by William Harvey, Realdus Columbus, Fabricius ab
Acquapendente, Pecquet, Aselli and a few others, the
doctrine of the circulation of the blood and of the part
played by the accessory chyle and lymphatic vascular
systems, became firmly established before the end of the
seventeenth century.

CHAPTER XXX

ADVANCES MADE IN iNTERNAL MEDICINE AND
IN THE COLLATERAL BRANCHES OF BOTANY,
PHARMACOLOGY, CHEMISTRY AND PATHO-
LOGICAL ANATOMY

General Remarks. — In the fundamental branches of
medical knowledge — anatomy and physiology — advances
of a very decided character were accomplished during the
sixteenth and seventeenth centuries; and in the preceding
chapters I have endeavored to give my readers some idea
of the nature of these advances, of the men who were
instrumental in effecting them, and of the extent to which
the way was made easy, during this period, for the accom-
plishment of still further advances. In carrying on the
work of correcting the many errors which were found to
exist in the two departments mentioned, it was. soon dis-
covered that the obstacles to be overcome were oiP a serious
character, and that the most formidable one of the group
was what is universally known as Galenism. If I now
refer to this subject once more, perhaps for the second or
third time in the course of this history, it is because I
fear that my remarks with regard to the harmful influence
exerted by Galenism may not be rightly interpreted. For
Galen's personal character I entertain, as I have already
stated in the section relating to Ancient and Mediaeval
Medicine, the deepest respect, and I am filled with great
admiration for what he accomplished in advancing the
science of medicine ; but at the same time I cannot overlook
the fact that he was hemmed in by insurmountable limita-
tions. No single human being, living at the beginning of
the present era and surrounded, as Galen was, by a herd of

388 GROWTH OF MEDICINE

jealous rivals, could have successfully bid defiance to those
who considered it sacrilegious to dissect the dead body of a
fellow man ; and yet, without the knowledge which may only
in this way be gained, how was it practicable for any
individual, no matter how clever he might be, to lay the
foundations for a further advance in medical knowledge?
It seems to me therefore plain that Galen did all that lay
in his power to advance the science of medicine; and
whatever words of condemnation I may have employed
in the text, when speaking of the Galenists, refer solely to
those physicians of later centuries who were of such a
narrow-minded type, so rigidly crystallized in the belief
that Galen's teachings had reached the limit of all possible
knowledge in the science of medicine, that they did not
hesitate to class the efforts of men like Vesalius as acts of
unpardonable impiety. Galenism, then, refers to the very
widely prevalent tendency among physicians of the fifteenth,
sixteenth and seventeenth centuries to uphold the teachings
of Galen as the only trustworthy code upon which they
should depend for their guidance. In short, Galenism, at
the period named, meant for medicine a complete arrest of
development.

I have now arrived at a point in the history of medicine
where, owing to the limited amount of space at my com-
mand, the difficulty of deciding as to what subjects and
what individual workers in the field of medicine — a field
now grown to very great proportions — shall receive con-
sideration in my sketch. Having decided from the very
outset that my best efforts shall be directed, consistently
with a strict adherence to historical truth, toward making
my account readable, I now find it absolutely necessary
to jettison — ^if I may be permitted to use such a nautical
expression — much really valuable cargo, and to put ashore,
before continuing our voyage, many passengers of un-
doubted worth. Nobody need bemoan the loss of all these
valuable treasures, for the great majority of them, I am
confident, will be cared for properly by those authors who
are privileged to treat this whole subject with some degree
of thoroughness; and the reader, if he is familiar with

ADVANCES IN INTERNAL MEDICINE 389

German, will even now find, in the excellent general
treatises of Haeser, von Gurlt, Pagel, Pnschmann, Baas-
Henderson and Neuburger, great stores of the most satis-
factory information concerning the thousand and one
details about which I am obliged to remain silent.

Internal Pathology. — During the fifteenth century the
practitioners of medicine in Italy and France were still
strongly under the influence of the teachings of the Arabian
medical authors. One of the first writers in Italy to place
the doctrines of internal medicine upon a firmer footing
was Antonius Benevienus, a native of Florence (1440-1502).
His treatise on some of the unusual causes of disease, which
was printed in Florence in 1506, is said to be written in very
clear language and to be based entirely upon cases which
came under his own observation. According to Haeser
the first improvements in the doctrines relating to patho-
logical anatomy may be credited to Benevienus, who also
taught that pathological phenomena should be studied by
direct observation rather than from books.

Johannes Manardus of Ferrara (1462-1536) was a very
sturdy opponent of astrology, and, in general, did all in
his power to weaken the prevailing blind trust in the
authority of the Arabian medical authors. But the two
physicians who, next to Fabricius ab Acquapendente, stand
out most conspicuously among their Italian contemporaries
of the sixteenth and seventeenth centuries, are Fracastoro
and Lancisi — the former a native of Northern and the latter
of Southern Italy.

Hieronymus Fracastoro of Verona (1483-1553) ranks
very high among the physicians of the first half of the
sixteenth century for his valuable contributions to our
knowledge of internal pathology. In the treatise which he
published in 1546 on contagious maladies, he states in plain
language his belief that the causes of diseases of this
nature are to be found in living germs that are endowed
with the power of propagating themselves. He divides
these diseases into the following three groups : —

1, Those which infect only by contact; 2, Those which not only
infect by contact, but at the same time leave behind a centre or

390 GROWTH OF MEDICINE

focus of infection — in which category he places tuberculosis,
elephantiasis, and similar diseases; and 3, Those which infect not
only by direct contact, or through the agency of a residuary centre
or focus of infection, but also those which are capable of spreading
their infective elements over wide areas — for instance, the pesti-
lential fevers, certain ophthalmias, variola, etc. (From Viktor
Fossel's version of Fracastoro's treatise published in Leipzig in
1910.)

Speaking of tuberculosis (called by him '* phthisis"),
Fracastoro says that it is astonishing for how great a
length of time the virus of this disease retains its infective
power. ''It has been noted, for example, that in quite a
number of instances the clothes worn by a tuberculous
patient have communicated the disease to a healthy indi-
vidual as late as two years subsequently to the date at
which they were removed from the original tuberculous
individual. ' ' The same power of communicating infection,
he continues, may reside in such other objects as the bed,
the walls and the floor of the room in which a tuberculosis
patient has died. Under these circumstances, he adds, we
are obliged to assume that germs of this infective disease
have remained attached to the different objects mentioned.

Fracastoro was born in Verona, Italy, of parents who
belonged to the patrician class and were in easy circum-
stances. He studied mathematics and philosophy at the
University of Padua, and was quite prepared, on reaching
the age of twenty, to pass the examinations required of
candidates for the degree of Doctor of Medicine. Just at
this time, however, Padua was not a safe place of residence,
owing to the war that was threatened between the Emperor
Maximilian the First and the Republic of Venice. Accord-
ingly Fracastoro took his degree at the newly established
Academy of Pordenone, in what is known to-day as the
Province of Udine (northeast of Venice) ; and shortly
afterward, upon the death of his father, he returned to
Verona and began the practice of medicine. As he quickly
gained the confidence of the people, he very soon found
himself in a sufficiently prosperous condition to warrant
him in retaining possession of the family residence, which

ADVANCES IN INTERNAL MEDICINE 391

was charmingly located at the foot of Monte Incaffi, midway
between the Adige River and the Lake of Garda. Here
it was that Fracastoro did a large part of his literary
work, for he was a poet as well as a physician. Pope Paul
the Third appointed him to the position of Physician -in-
Ordinary to the Council of Trent, and it was by his advice
that, upon the appearance of the Plague in that city, the
sittings of the Council were thereafter held for a short
season at Bologna. Later, still other honors fell to his lot.
He enjoyed the esteem of the Emperor Charles the Fifth
and of Francis the First, King of France; and the latter 's
highly cultivated sister, Margaret of Navarre, offered him
every inducement to settle at her Court, but the attractions
of his own home made it easy for him to decline all these
offers. He died at his villa on August 6, 1553, and six years
later the city of Verona erected in his honor a marble
memorial tablet.

Fossel, in his biographical sketch of Fracastoro, says
that the most popular of his poetical writings was that
entitled, ^^ Syphilis sive morbus Gallicus.^^ It was pub-
lished in several successive editions, and was translated
into nearly all the languages of European countries. I
shall have occasion to refer to it again in a later chapter.

Giovanni Maria Lancisi was born at Eome on October 26,
1654. Like Boerhaave he began his university studies
under the service of the Church, but, as time went on, his
leaning toward the profession of medicine became more
and more pronounced, and he soon took up in earnest the
study of that science at the University of Sapienza,
devoting a large share of his time to dissecting and to
clinical work in the hospitals. In 1672, when he was only
eighteen years old, he was given the degree of Doctor of
Medicine ; and four years later, after a competitive exami-
nation, he was appointed an assistant at the Hospital of
the Holy Ghost. In 1678 he was permitted, as a special
honor, to enrol himself as a student in the College de Saint-
Sauveur. During the following five years he enjoyed at
this institution exceptional facilities for studying medical
literature, and was thus able to accumulate an immense

392 GROWTH OF MEDICINE

mass of useful extracts from the writings of the best
authors. In 1684 he was assigned to the duty of teaching
anatomy at the Sapienza, and for thirteen years he filled
this post with great credit to himself ; Malpighi being one
of those who took pleasure in following his lectures. He
had scarcely attained his thirtieth year when he was
honored by being appointed Physician-in-Chief and Privy
Councilor to Pope Innocent the Eleventh; and soon after-
ward he was made a Canon of the Church of Saint Law-
rence, the main purpose of which appointment was to
provide him with a suitable income. On the death of the
Pope in 1689 he resigned the latter office, in order that he
might have more leisure and freedom to pursue his profes-
sional duties. Subsequently he became the regular medical
attendant, first of Pope Innocent the Twelfth and afterward
of Pope Clement the Eleventh. He died on January 21,
1720.

Von Haller speaks of Lancisi as *'a physician who was
most highly esteemed by Pope Clement the Eleventh, who
was very learned and very philanthropic, and who loved
to give aid to the afflicted and to prevent litigation by wise
counsels." It was Lancisi also, as I have stated on a
previous page, who discovered at Rome, in the possession
of the heirs of the artist Pini who made the original draw-
ings, the copper plates which Eustachius had ordered nearly
two hundred years earlier, and which were to have been
used by this celebrated anatomist in the production of a
most beautiful set of anatomical illustrations.^

The two most important original treatises published by
Lancisi bear the following titles: *'Z)e motu cordis et
aneurysmatihus^^ (on the movements of the heart and on
aneurysms), Rome, 1728 (a later edition in 1745); and
**Z)e suhitaneis mortibus Lihri IP^ (on sudden deaths),
Rome, 1707 (also later editions).

Botany and Botanical Gardens. — The Egyptians, the
Persians, the inhabitants of India and China, and the
ancient Greeks accumulated a great mass of information

1 An edition of the completed set of these plates was published hj Lancisi
at Borne in 1714.

ADVANCES IN INTERNAL MEDICINE 393

relating to plants which might be utilized in the treatment
of different diseases. Then, in the early part of the present
era, Galen contributed not a little to our further knowledge
on this subject; but from that time forward, until the six-
teenth century, pharmacology practically remained un-
changed. The beginnings of a systematic study of all
plants — in other words, modern botany — may be traced to
the establishment of botanical gardens, first in Italy and
afterward in Holland and France.- According to Berendes
the very earliest attempt in relatively modern times
to cultivate such a garden was made at Salerno by
Matthaeus Silvaticus. Then Master Gualterus, in 1333,
was permitted by the Governing Council of Venice to make
use of a certain plot of ground for the cultivation of the
plants in which he was specially interested. So far as one
may judge, however, both of these were private under-
takings. In 1545, at the request of Francesco Buonafrede,
Professor of Therapeutics at the University of Padua, the
Senate of that city laid out a garden for his uses in teaching.
This appears to be the earliest instance of the establishment
of a botanical garden in connection with a regularly
organized medical school. Then, in fairly quick succession,
similar gardens were established at Pisa (1547), Bologna
(1567), Leyden, Holland (by Boerhaave in 1577), and
Heidelberg (1593). In France the University of Mont-
pellier received its first botanical garden in the year last
named. Thus it appears that about the middle of the
sixteenth century botany began to receive attention as a
branch of knowledge which, as was then believed, it was
important for physicians to study; and from that time
forward, for more than two centuries, it formed a regular
part of the curriculum in all the leading medical schools.
The two chairs of botany and anatomy were not infre-
quently combined. Fallopius, for example, held the Chair
of Anatomy, Surgery and Botany in the University of
Padua, and so also did Vesling in the same university at a
somewhat later date. The first systematic works on botany
were also published in the sixteenth century. They were
all written by German or Swiss authors, the most note-

394 GROWTH OF MEDICINE

worthy one of the collection being that of Conrad Gesner
of Ziirich (1516-1565), who is spoken of by Haeser as ''a
man of noble birth, of extraordinary industry, of extensive
knowledge in every department of natural history, and the
author of a large number of treatises, which, by reason of
their intrinsic value, cannot fail to perpetuate the memory
of this distinguished scientist throughout all time." He
had much to contend with throughout his short but eventful
life. In the first place, he was very poor — so poor that both
he and his young wife were obliged to support themselves
during the early years of their married life by teaching
school. Then he studied medicine at Basel, and afterward
accepted the professorship of Greek, first at Lausanne and
then in turn at Basel and at Ziirich. From the beginning
to the end of his career he was hampered by poverty and
by frequent illnesses. But, despite these obstacles and also
notwithstanding the fact that he was an indefatigable
worker in matters relating to natural history, he is reported
to have played one of the most influential parts in the drama
of the Reformation. Only a man of exceptionally strong
character and of unusual ability would have found it
possible to attain the success which Gesner attained in these
different undertakings and under such unfavorable circum-
stances. Andreas Caesalpinus, whom I have already men-
tioned as one of the earliest investigators of the question
of the circulation of the blood, also interested himself in
the science of botany. Puschmann speaks of him as the
greatest botanist of the sixteenth century. For several
years he was Professor of Philosophy and Medicine in the
University of Pisa, but at a later date Pope Clement the
Eighth chose him to be his private physician and also
appointed him Professor of Medicine in the University of
Sapienza at Rome. His death occurred in the latter city
in 1603.

Before dismissing all further consideration of the part
played by Italian and Spanish physicians during the six-
teenth century in the advancement of the science of medi-
cine, I shall briefly mention a few additional discoveries in
botany and pharmacy that may serve to render the present

ADVANCES IN INTERNAL MEDICINE 395

account more complete. In 1518 the monk Romano Pane
published the first account of the discovery of tobacco in
America. In 1560 Jean Nicot, a French diplomatist, brought
back with him from Portugal (to which country he had
been sent as an ambassador) a small supply of the seeds
of the plant. To commemorate this service the alkaloid
found in the leaves of the tobacco plant was given the name
of nicotine. Capsicum was made known to the world by
Dr. Chanca, a companion of Christopher Columbus on the
occasion of his second voyage (1493) to America. Balsam
of Copaiva was discovered by a Portuguese monk in Brazil
at some time between the years 1570 and 1600. It is men-
tioned for the first time in the Amsterdam Pharmacopoeia
of 1636. Monardes described the Peruvian and Tolu
balsams in 1565. Cacao was first made known to Europeans
by Fernando Cortez in 1519. About the year 1550 coca was
introduced as a drug that possesses the power of allaying
hunger and of enabling one to endure the fatigues attending
prolonged expeditions. Sarsaparilla came into use at
about the same date. Then followed jalap in 1556 and
sassafras toward the end of the century.

In Germany and in the Netherlands there were, during
the sixteenth century, very few physicians who manifested
any marked degree of learning in the science of medicine.
The teachings of Paracelsus met with a favorable reception
in these parts of Europe and they continued to hold
supreme sway over the minds of men during a long period
of time. There were some physicians, however, who had
received their early professional training in Italy and
France, and who for this reason were less ready to accept
unreservedly the doctrines of Paracelsus ; and, among these
more independent spirits, Eembert Dodoens (Dodonaeus,
1517-1586) of Malines, near Antwerp, distinguished himself
by making a number of valuable contributions to the science
of medicine. He held the Chair of Medicine at the Univer-
sity of Leyden and was also the personal physician of the
Emperors Maximilian the Second and Rudolphus the
Second. He was a very accurate observer, and his writings
are particularly rich in matters relating to pathological

396 GROWTH OF MEDICINE

anatomy; for which reason not a few authorities are
inclined to credit him with the honor of being the founder
of this department of medical science. Felix Platter of
Basel, Switzerland, of whose experiences as a student at
the University of Montpellier I have given a brief account
on a previous page, and who was at this time Professor
of Medicine in his native city, was also greatly interested
in pathological anatomy. Haeser gives him credit for
publishing a number of valuable contributions to this
department of medical knowledge, and also for making the
first attempt at a classification of diseases.

Before I close this chapter it seems only fair that I
should add a few comments upon the careers of two
physicians whose professional attainments entitle them to
some consideration. The men to whom I have reference are
Marcello Donato and Eaymond Minderer.

Marcello Donato was a distinguished medical prac-
titioner of the city of Mantua, Northeastern Italy, who died
about the year 1600. He was one of the few who, at that
early period, taught that it was very important to study
disease from nature — i.e., from direct observation — and not
from books. His description of the epidemic of small-pox
of 1567 (published at Mantua in 1569) is worthy of
commendation. His chief work, however, is that which
bears the title ^^De medica historia mirabili etc.'' (Mantua,
1586.) It contains a remarkably large and complete collec-
tion of rare and extraordinary cases belonging to every
department of medicine, and in his descriptions Donato pays
particular attention to the pathologico-anatomical aspects
of each case. He reports, for example, the instance of a
Caesarian section performed on a living woman in 1540
by Christopher Bain ; the child being found dead. Another
interesting case reported by Donato is that of a child in
whose ear a cherry pit had been allowed to remain undis-
turbed until it began to sprout; after which it was found
easy to remove the impacted object. In a somewhat
similar case which Donato also reports, the sprouting of
the seed of Anagyris was hastened by the presence of a
purulent discharge from the ear. In both instances all

ADVANCES IN INTERNAL MEDICINE 397

attempts to extract the foreign body had failed until the
sprouting had caused the seed to split. Finally, there is
recorded the case of a young man into whose nasal passage
a leech had penetrated, while he was bathing, and had then
taken up its abode far back in the canal. Donato, by aid
of direct sunlight, ''discovered the creature in that part
where the nasal channel merges into the oral cavity.'*
Presumablj^ he succeeded in removing the animal, but the
text quoted by von Gurlt (Vol. II., p. 517) furnishes no
further particulars.

CHAPTER XXXI

CHEMISTRY AND EXPERIMENTAL
PHARMACOLOGY

The experiments which were carried out by Antonius
Musa Brasavola, in the early part of the si:^eenth century,
upon animals and criminals, for the purpose of learning
the effects produced by certain drugs when administered
internally, afford one of the earliest instances of a genuine
experimental pharmacology. The account of these experi-
ments, which was published at Rome, in 1536, under the
title ^^Examen omnium simplicium, quorum usus est in
publicis officinis,^' deserves honorable mention. An even
more remarkable evidence of the research spirit which was
abroad at that period is to be found in the work done by
Fortunatus Fedelis, a native of Palermo, Sicily, and an
ardent champion of the direct method of observation as
applied to therapeutics.

Van Helmont, of whose life and contributions to the
science of medicine I now propose to furnish a sketch,
represents in a certain sense Paracelsus' successor; and,
as a matter of fact, he was even more closely associated
with the development of chemistry as an independent
science than was his predecessor.

Jean Baptiste Van Helmont was born at Brussels in
1577. His parents, who belonged to the nobility, possessed
ample financial means and were therefore able to give their
son every opportunity to secure a liberal education. While
still a lad he enrolled himself among the students of the
University of Louvain, and advanced so rapidly in his
studies that, already at the early age of seventeen, he had
passed all the examinations required of applicants for the
degree of Master of Philosophy. He was not willing.

CHEMISTRY AND PHARMACOLOGY 399

however, to receive this honor at that time, feeling that he
had not acquired suJBficient knowledge to justify such
acceptance; and from that date forward he turned his
attention to the study of other branches of learning.
Finally, in 1599, he accepted from the same university the
degree of Doctor of Medicine, and soon afterward left
Belgium with a large party of his friends to make an
extensive toiir through the Alps of Switzerland and Savoy.
After his return home in 1602 he devoted his attention
chiefly to chemical researches ; but in a very short time he
started off again on a journey to Spain and France, and
eventually to England, where he spent nearly a year in the
city of London, returning to Belgium in 1605. He married,
about this time, a rich heiress of Wilworde, in the neighbor-
hood of Brussels, and resumed with great zest his labors in
chemistry and alchemy. He was thus enabled to manu-
facture many remarkable remedies with which — as he
himself declared — he succeeded in curing myriads of
patients who had failed to receive any benefit whatever
from the ordinary resources of medical science. He died
on December 30, 1644.

I do not feel equal to the task of expounding Van Hel-
mont's often very obscure theories regarding the physical
and psychological processes that take place in the human
being; regarding the distinctions which he makes between
the ^^archaeus influus^' — the regulating principle which
governs all the psychical and physiological processes in
the body — and the ^^archaeus insitus^^ — the subsidiary
power which resides in each individual part of the body,
but which at the same time is under the control of the
'^archaeus influus^'; and regarding the doctrine that dis-
ease is the result of an ^'idea morbosa^' of the '^archaeus
influus.^* August Hirsch says that in developing these
theories Van Helmont puts forward many bright ideas,
which unfortunately lead one into a wilderness of fantastic,
theosophic concepts. If suflQjj^ent time and space were at
my command it might be interesting to separate some of
these bright thoughts from the extravagances in which they
are buried, and thus demonstrate the truth of the state-

400 GROWTH OF MEDICINE

ments made by both Hirsch and Dezeimeris to the effect
that Van Helmont, in matters relating to physiology and
pathology, was unquestionably a precise and critical
observer, a sound thinker, and a correct interpreter ; but
the plan of the present work will not permit me to enter
into all these details. I can only quote a few of the teachings
or sayings to which Hirsch refers : —

Digestion does not, as Galen maintains, depend upon heat, but
upon a certain ferment existing in the gastric juice.

Heat is not, as has hitherto been taught, the cause of life, but
rather one of its products.

The final cause of the sensory phenomena of life is the archaeus
influus, which, while it is inseparably united with matter, neverthe-
less does not represent the soul itself, but rather the organ of the
soul, and is seated in the "duumvirate" of the spleen and the
stomach.

Disease, in order to acquire sufficient power to antagonize life
effectively, must unite its forces with the archaeus influus.

It is claimed that Van Helmont, more than any other
teacher of medicine, was instrumental in giving the death-
blow to the practice — which prevailed in all the medical
schools of that day — of teaching the obsolescent Galenic
doctrines, and that for this valuable service alone he
deserves full recognition at the hands of the medical
profession of to-day. But, as we learn from Ernest von
Meyer's history of chemistry. Van Helmont has a much
stronger claim for recognition in the fact that he made
many important contributions to iatrochemistry and also
to fundamental or pure chemistry. Taking one thing with
another, says von Meyer, we may safely assert that Van
Helmont 's useful contributions to the medical and chemical
sciences by far outweigh those which are of a fantastic or
useless nature. It was he, for example, who materially
increased our knowledge of the nature of carbonic acid.
He demonstrated how it may be extracted from limestone
or from potash by the aid of acids, from burning coal, and
from wine and beer while they are undergoing fermentation.
He also showed that it is present in the stomach, in various

CHEMISTRY AND PHARMACOLOGY 401

mineral waters, and in hollows in the earth. He gave it
the name of ^^gas sylvestre.''^ He would doubtless have
carried his discoveries much farther along if he had
possessed the apparatus which is required for such re-
searches. However, despite the lack of these facilities, he
was able to describe hydrogen and marsh gas as special
varieties which do not possess the same composition as
ordinary air. Finally, in his treatise entitled ^^Pharma-
copolium ac dispensatorium modernum^^ will be found a
goodly number of useful instructions as to the proper
manner of preparing drugs.

A complete collection of his writings was published at
Amsterdam by his son, in 1648, under the title ^'Ortus
medicinae vel opera et opuscula omnia.''^

Theophrast von Hohenheim — who is known everywhere
throughout the world as ** Paracelsus" — was the son of
Wilhelm Bombast von Hohenheim, a physician who
belonged to one of the noble families of the Duchy of
Wiirttemberg. He was born in 1493 at a spot called ^^Das
Hohe NesV^ (the lofty nest) in the Canton of Schwyz,
about one hour's distance from the celebrated monastery
or cloister of Einsiedeln, of which institution his father
was the official physician. Switzerland, therefore, has a
right to claim Paracelsus as one of her sons. In 1502 his
father transferred his home to Villach, in Carinthia (to
the east of Tyrol), and continued to live there up to the
time of his death in 1534. It is not known where the son
obtained his degree of Doctor of Medicine. It is a well-
established fact, however, that he received the first part
of his training as a chemist from Johann Trietheim, the
Prior of Sponheim, and his subsequent education in the
laboratory of Sigmund Fugger, the cultivated owner of
wines at Schwatz in the Tyrol. He traveled all over
Europe, going from one university to another and making
the acquaintance of people who were well informed in
matters relating to natural history, chemistry and metal-
lurgy ; and during all this time he appears to have absorbed
a great deal of information relating to almost every
department of human knowledge. Finally in 1526, soon

402 GROWTH OF MEDICINE

after he had returned to Switzerland, he received, through
the aid of certain influential citizens, two important official
positions in Basel, — that of City Physician and that of
Professor of Medicine and Surgery in the University. To
the surprise of all, and contrary to long-established custom,
he delivered his lectures in German and not in Latin. This
action on his part called forth bitter criticism from the
university authorities, but at first it met with the approval
of the students. During the following two years, however,
he gradually became unpopular with all classes of the
community, and was finally obliged to leave Basel. Haeser
attributes this unpopularity to Paracelsus ' rough manners,
to his intolerance of the opinions of his colleagues, and to
his tirades against the apothecaries for their excessive
charges. It is very difficult to determine how far jealousy
was responsible for the state of affairs which I have just
described. Cabanes, the author of an admirable biography
of Paracelsus {Revue Scientifique, Paris, May 19, 1894),
gives his own estimate of this remarkable man's character
in the following terms : ' ' Poor, miserable, and persecuted
during his lifetime, he was misunderstood even after his
death, and was calumniated by history." Paracelsus
evidently believed it to be his bounden duty to destroy the
then prevailing cult of Aristotle, Galen and Avicenna as
the great teachers in medicine ; and, filled with this idea, he
prophesied the growth of a new science of medicine on the
ruins of their teachings. It is stated that the students,
after one of these excited lectures, made a bonfire and
burned a number of copies of the works of these famous
authors, thus showing that Paracelsus was sufficiently
eloquent to infuse some of his own reforming spirit into
the minds of his auditors. He made a great mistake, how-
ever, when he attacked in a similarly violent manner the
shortcomings of many of his contemporaries. *'The med-
ical profession," he said, ''has become a mere money-
making business." As a natural result of such tirades,
Paracelsus was forced to leave Basel. He fled first to
Colmar in Alsace and at a later date took refuge in St. Gall,
Switzerland ; and it was while he resided in that city that

CHEMISTRY AND PHARMACOLOGY 403

he published three books of his ^^Paramirum.^^ Then in
1535 he once more resumed his wandering life, in the course
of which he visited Poland, Lithuania, lUyria, etc. On
reaching Salzburg, in Austria, he fell ill and died on
September 24, 1541, at the age of forty-eight.

Paracelsus was a prolific writer. To all the treatises
which he published he gave extravagant titles. To his
principal work, for example, he-gave that of ^^Parami-
rum^^ — The Surprising Marvel; to another, that of
^^Paragranum^^ — Grain of Superior Quality; and to a
third, that of '^Archidoxia^^ — Transcendental Science.
He wrote treatises on syphilis, on the plague, on epidemics,
on the diseases of grave-diggers, on ore-smelters, etc. It
is admitted by all his critics that he devoted altogether too
much time and thought to alchemy, demonology, necro-
mancy, etc. Cabanes quotes Cruveilhier as saying that
Paracelsus believed in the reality of beings of a fantastic
nature, but attached little or no importance to them. Then ^
Cabanes himself adds : ' ' The thing which more than any- J
thing else absorbed his thoughts was the irresistible desire
to overthrow the Galenic idol and substitute for it the
science of experience, of observation pure and simple."
Bordes-Pages, another distinguished French physician,
says of this extraordinary man: ''The great glory of
Paracelsus is to be found in the facts that he cast off the
yoke of a former epoch, more speculative than practical;
that he summoned physicians to resume their allegiance to
experience; and that he opened a long career for the
alchemists, upon whom he urged the duty thenceforward
of making new remedies the principal object of their
researches He simplified and spiritualized thera-
peutics." Some of Paracelsus' o^ti sayings are worth
preserving: ''Without air all living creatures would
perish from suffocation." "Man is the supreme animal,
the one last created." *^Alterius non sit, qui suus esse
potest" [He who is able to be his own master should not
allow himself to be led blindly by another]. When he was
accused of being coarse-grained and of deceiving the people,
he replied: "By nature and also owing to the kind of

404 GROWTH OF MEDICINE

people with whom I associated in my youth I am not of a

finely-spun texture We were not nourished with

figs and white bread, but with cheese, milk and black

bread — food that does not make delicate lads They

say of me that I lead the people astray, that I am possessed
of a devil, that I am a sorcerer, and that I am a magician.
Whatever truth there may be in these charges, one thing
is certain: You are all of you unworthy to unloose the
latchets of my shoes." (From Paragranum, II., 120.)

Oporinus, who acted for a long time as Paracelsus*
assistant, made the following statements with regard to
some of the methods of his former master : —

He always kept several preparations stewing on his furnace —
as, for example, a sublimate of oil or of arsenic, a mixture of saffron
and iron, or his marvelous Opedeldoch. He never prescribed a
special diet nor any hygienic measures. As a purge he gave a
precipitate of theriaca or of mithridate, or simply the juice of
cherries or grapes, in the form of granules (about the size of the
droppings of mice), and he was careful always to give them in
uneven numbers (1, 3, or 5). He was bitterly opposed to the
polypharmacy which prevailed so widely in his day,

Cabanes says that we probably owe to Paracelsus an
increased knowledge of the virtues possessed by the
different preparations of antimony, mercury and iron, and
by salines. It was he who created the distinction between
officinal and magistral preparations. To our list of
pharmaceutical preparations, he added tincture of helle-
bore, compound tincture of aloes, digestive ointment, the
tincture of metals (''Lilium" of Paracelsus), the ''Saffron
of Mars," etc. He was the inventor of the precious
preparation known as "/a mumie,^' a preparation which
was popularly believed to possess marvelous healing
powers. Ambroise Pare, toward the end of his career, was
greatly blamed because he did not employ this remedy, and
he was finally compelled in self-defense to write a pamphlet
on the subject. (The text is reprinted in Malgaigne's
'■^Ambroise Pare/' under the title of ^'Traite de la mumie
et de la licorne.^^)

CHEMISTRY AND PHARMACOLOGY 405

Adolphe Gubler of Paris credits Paracelsus with the
distinction of having been the first physician to give an
impetus to the movement which had for its object the
application of chemistry to the perfection of medicinal
preparations. He also maintains that Paracelsus should
be looked upon as in a large degree the originator of
specific remedies, and that he is justly entitled to the
distinction of having been the first publicly to announce
the ''quintessences" — that is, the active principles (vege-
table alkaloids) — of drugs. According to this claim it is
understood that Paracelsus taught that each drug contained
a specially active elementary body which it was possible
to extract as a separate substance. Acting upon this belief
Paracelsus did not hesitate to give the preference to the
pharmaceutical preparations known as ** tinctures" — that
is, alcoholic extracts. Great credit is also due to Paracelsus
for his rejection of the doctrine that guaiac is an efficient
remedy against syphilis, and for his insistence that mercury
is the only useful agent in curing that disease. Tartar
emetic (potassium antimonyl tartrate) is one of the drugs
the introduction of which into our pharmacopoeia should
be credited to Paracelsus.

One of the earliest references to genuine diphtheria is
to be found in the writings of Paracelsus, who speaks of
the disease in the following terms : —

When this disease is located in an external wound it not infre-
quently spreads to the muscles of the larynx ; and, vice versa, when
a person has the disease in his throat, and at the same time happens
to have an external wound, the malady is likely to spread to the
wound.

Paracelsus* idea of the existence of an ''archaeus,^' a
power which presides over all physiological actions as well
as over all the operations of medicinal drugs, resembles
very closely the ** vital force," or '* animism" so strongly
championed by Stahl in the seventeenth century.

From all that I have said above regarding the excitable
nature of Paracelsus it seems almost a waste of time to
tell our readers that his contributions to the science of

406 GROWTH OF MEDICINE

surgery were of very slight value. He despised the study
of anatomy, claiming that a knowledge of this branch of
medical science was not essential to a proper acquaintance
with the human body. *'To dissect," he once remarked,
"was a peasant's manner of procedure." (Cabanes.) His
surgery, as one may imagine, showed clearly the bad effects
of such beliefs.

During the latter part of the nineteenth century there
developed among the leading men of the medical profession
a sentiment in favor of honoring the memory of Paracelsus
by the erection of a suitable monument at Basel, Switzer-
land, the city in which he made his first public appearance.
The project met with a favorable reception and the statue
is now an accomplished fact. This is a remarkable instance
of tardy justice being rendered to the memory of a physi-
cian who, for three hundred years, was almost universally
looked upon as a vain, half -crazy man.

The next advances of any special importance in the
department of chemistry were made in Great Britain by
Robert Boyle, who was born at Lismore, County of Cork,
Ireland, on January 25, 1626. He was the fourteenth child
of the Earl of Cork. His early training was obtained at
Eton, and then afterward he spent two years at Geneva,
Switzerland, in prosecuting his scientific studies. In 1654
he entered Oxford University and became intimately
acquainted with some of the most learned men of that day.
While he was a student at the university he became a
member of what was known as ''The Invisible College,"
a society which was influential in bringing about the
founding of "The Eoyal Society," of which organization
he was president from the year 1680 to the time of his
death in 1691.

Boyle was endowed with a noble character — ^modest,
religious and generous. He gained distinction as a chemist
in several departments. Applied chemistry is indebted to
him for a number of important contributions ; he added to
our knowledge of chemical combinations and to the methods
of analyzing them; he enriched the chemistry of gases and
also pharmacology; and he gave a clear and easily intelli-

CHEMISTRY AND PHARMACOLOGY 407

gible definition of what a ''chemical element" is. He laid
stress upon the doctrine that a chemical combination
represents the union of two component elements, and that
this combination possesses characteristics quite different
from those possessed by either of the two component
elements. Before his day there was practically no such
thing as analytical chemistry, and it is to Boyle that we
owe the establishment of a clear conception of what the
terms ''chemical reaction" and "chemical, analysis"
signify. The part played by atmospheric air in combustion
was made by him the subject of numerous experiments
which proved later to be of great assistance in the final
solution of the problem.

In one of his writings Boyle says in substance that if
men would devote their energies to carrying out experi-
ments and collecting observations, rather than to the
constructing of theories without having previously tested
with thoroughness the grounds upon which they believe
them to be based, the world would be greatly the gainer.
The promulgation and insistence upon the importance of
this doctrine for the growth of the science of chemistry
constitute — so those competent to judge claim — Boyle's
greatest merit in scientific work and his most important
contribution to chemistry.

Among the chemical treatises which Boyle wrote and
published the following deserve to receive special mention:
"Sceptical Chymist," 1661; '^Tentamina quaedam physio-
logical^ 1661; ^^Experimenta et consider ationes de colori-
hus,'' 1663; and "Medical Experiments," 1692-1698.
Although Boyle was not an avowed follower of Bacon, he
carried out thoroughly the principles which the latter
taught.

Raymond Minderer, a practicing physician in Augsburg,
Germany (1570-1621), deserves the credit of having added
to our stock of remedies the acetate of ammonia {liquor
ammonii acetatis). Diluted with an equal quantity of
water it is still employed to-day as a remedy under the
name of "Spirit of Mindererus." He was the compiler,
in 1613, of the Augsburg Pharmacopoeia.

408 GROWTH OF MEDICINE

General Therapeutics. — Transfusion.^The Discovery of
Cinchona and Ipecacuanha. — In the department of general
therapeutics, as we learn from Berendes, several important
new measures were brought forward during the seventeenth
century; and among these the following deserve to receive
brief mention in this place: the operation of transfusing
blood from a healthy individual to one who is ill; the
introduction of cinchona into the European pharmacopoeia
as an efficient remedy in the treatment of certain fevers;
the similar introduction of another South American drug —
viz., ipecacuanha; and the invention of many medico-
chemical products and the improvement of others that
were already in common use.

As regards the operation of transfusion, from which
great things were expected, Sir Christopher Wren (1632-
1723), the famous architect and astronomer of London, is
reported to have been the first person to urge a trial of
this procedure. On the other hand, Robert Boyle, the
chemist, actually performed the operation on animals. He
followed the method suggested by Richard Lower (1631-
1691) of England, viz., by allowing the blood to flow from
the carotid artery of one animal into the jugular vein of a
second animal; while Edmund King adopted the plan of
allowing the blood to pass from the jugular vein of one
animal into the corresponding vein of a second animal.
Upon a human being the operation was probably performed
for the first time (in 1666) by Denys, Professor of Phi-
losophy and Mathematics in Paris. Repetitions of the
operation were made, two or three years later, in London
and in Rome, but they produced no good effects and in some
instances they terminated in the death of the individual
for whose benefit the operation had been performed. In
1668 the French Parliament and the Papal Government
forbade a repetition of the operation.

In 1638 — so the story runs — the wife of Count Cinchon,
Viceroy of Peru, was cured of a stubborn intermittent fever
by the native physicians, who employed, in their treatment
of the malady, the bark of the tree now universally known
by the name of ** Cinchona." In 1640 Juan del Vego, the

CHEMISTRY AND PHARMACOLOGY 409

regular medical attendant of Count Cinchon, introduced
the new remedy into Spain, but it was not until after the
lapse of about fourteen years that the drug found its way
into England and Central Europe. The price at which it
could be purchased was at first very high; it was almost
literally ''worth its weight in gold." Even as late as 1680
the bark sold in England for £8 sterling per pound. Not-
withstanding the generally recognized value of the drug
in the treatment of certain fevers there were not a few men
who continued for many years to oppose its use. Thus,
Johann Kanold, a practitioner of medicine in Breslau,
Germany, is reported to have said, on his deathbed in 1729,
that he would rather die than be cured by a remedy the
action of which was so opposed to all the principles which
he considered right in therapeutics.

Ipecacuanha, another very important drug, was added
to our stock of remedial agents toward the end of the
seventeenth century. It was brought into France from
Brazil, in 1672, by a French physician named Le Gras, but
its value as a remedy for the cure of dysentery did not
begin to be appreciated until after Helvetius, a semi-quack,
had sold to Louis the Fourteenth, for one thousand
louis-d'or (about $4000), the formula for the preparation
which he (Helvetius) had been using with great success
during the recent epidemic of that disease, and which
moreover had effected a remarkably rapid cure in the case
of the King's own son — the Dauphin. After the purchase
had been made by Louis the Fourteenth, in the interest of
the French people in general, it was ascertained that the
only active reagent among the ingredients of the formula
was ipecac, a drug with which the Paris physicians had
long been more or less familiar. Ipecac, it will also doubt-
less be remembered, constitutes the important element in
what is known as the East Indian treatment of dysentery.

Probably the earliest modern treatise on matters con-
nected with pharmacy is that which bears the title
*^Onomasticon Latino-Germanico-Polonicum rerum ad
artem pharmaceuticam pertinentium.^^ It was published
about the year 1600, and its author was Paul Guldinus.

410 GROWTH OF MEDICINE

One of tlie most important iatrochemical authorities of
the seventeenth century was Johann Eudolf Glauber (1604-
1668), to whom we are indebted for the invention or
improvement of a large number of medico-chemical
products. The well-known *' Glauber's salt" may be
named as one of these products, and chloride of iron as
another.

CHAPTER XXXII

SOME OF' THE LEADERS IN MEDICINE IN ITALY,
FRANCE AND ENGLAND DURING THE SIX-
TEENTH AND SEVENTEENTH CENTURIES

Eminent French Physicians. — Among the physicians of
France who attained a widespread and well-grounded
celebrity throughout Europe during the sixteenth century,
Pierre Brissot deserves to be given the first place. He was
born in 1478 at Fontenay-le-Comte, not far from Rochelle,
and was a professor of medicine at Paris. He attained
considerable distinction, during the sixteenth century, by
his advocacy of the superiority of the Hippocratic method
of bloodletting over that introduced — or, rather, perpet-
uated— by the practitioners of that day in Central Europe.
The rule which was laid down by Hippocrates was to the
effect that, in venesection, the blood should be drawn from
the vein lying nearest to the part inflamed. The Greek
physicians of a later period forgot all about this rule and
adopted in its place one that was based on the doctrine
that venesection practiced in the vicinity of a focus of
inflammation favors a determination of blood to that part
and therefore does only harm; and they accordingly —
especially in cases of pleuritis — abstracted blood from the
arm on the side opposite to that on which the disease was
located, or from one of the veins of the foot. This new rule
was subsequently adopted by the Arabian physicians, and
it remained in full force up to the end of the sixteenth
century. A wide experience in the treatment of the epi-
demic pleuritis which raged in Paris in 1514 confirmed
Brissot in the belief that the Hippocratic method is the one
to be preferred; but, despite his pleadings, the Parisian

412 GROWTH OF MEDICINE

physicians refused to adopt the method which he advocated
and used their influence in securing from the French
Parliament an order forbidding him to continue employing
it in Paris. Discouraged by the treatment which he expe-
rienced in that city, Brissot removed to Lisbon in Portugal,
and soon had occasion (in the epidemic which raged at
Evora in 1516) further to satisfy himself that the Hip-
pocratic rule is the correct one. But here too he encoun-
tered bitter opposition on the part of the Portuguese
physicians; his most active opponent being Dionysius, the
Physician-in-Ordinary to the King. Brissot then wrote an
elaborate defense of the method which he advocated, and
this treatise was submitted to the judgment of the Medical
Faculty of the University of Salamanca. When the deci-
sion of this learned body was given in Brissot 's favor, his
opponents, dissatisfied with the result, made still another
effort to gain their point, viz., by appealing to the Emperor
Charles the Fifth. They assured his Majesty that the
Brissot Heresy, as they termed it, was fully as dangerous
to the cause of humanity as that championed by Luther.
But here again they failed. This final victory, however,
brought no satisfaction to Brissot, who died of dysentery
in 1522, just before the decision was rendered. Haeser
speaks of this unusually bitter dispute as one of the last
of the violent battles which occurred between the adherents
of the Arabian physicians and the supporters of the
teachings of Hippocrates, and which terminated in '*a most
brilliant victory of experience over Arabian dogmatism."
During the first half of the sixteenth century there
developed a belief, among the more ignorant physicians,
that, in many cases of illness, important information may
be derived from a simple naked-eye inspection of the
patent's urine as exposed to view in a flask-shaped glass
vessel. In the Hippocratic writings no adequate grounds
for such a belief are discoverable, but in one of Galen's
treatises there have been found statements which appear ( ?)
to give some sanction to this new idea. However this may
be, it is an established fact that uroscopy was taken up at
the time named with great zeal by all the quacks in the

FIG. 16. "THE LOVESICK MAIDEN."
(After the painting by Jan Steen, 1626-1679.)

One of this famous Dutch artist's objects, in painting the scene here
represented, was to satirize the practice, which was very prevalent among
certain physicians of that period, of pretending to diagnose all sorts of
maladies from the mere naked-eye inspection of his patient's urine.

(Courtesy of Dr. Eugen Hollander, author of Die Medizin in der klassi-
schen Malerei, Stuttgart, 1903.)

SOME LEADERS IN MEDICINE 413

land and by large numbers of practitioners of medicine
who saw in this procedure an easy and safe method of
bettering their fortunes. The public at large were greatly
impressed with this new and wonderful manner of detecting
disease, and for a long period — ^indeed, for more than half
^ a century — this piece of clap-trap charlatanry continued
1 to thrive, and to reflect only discredit upon the medical
profession. There came a time, however, when people
generally began to suspect that uroscopy was not all that
the charlatans claimed it to be, and these suspicions were
voiced in the popular saying, * ' The pulse is good, the urine
is normal, and yet the patient dies." The writers who were
the most active in showing up the hollowness of the claims
of the uroscopists were Scribonius of Marburg, Germany,
Peter Foreest (1522-1597) of Alkmaar, Holland, and
Leonardo Botallo of Asti, in Piedmont (born in 1530). The
latter authority, it may be recalled, owes his chief distinc-
tion to the fact that he rediscovered what has been
erroneously named in his honor the ^^ foramen BotallV^ —
i.e., the ductus arteriosus in the foetus. He also attained
some distinction in another direction. He revived the
violent disputes about venesection by recommending a
resort to this therapeutic procedure in nearly all illnesses.
He went so far as to advocate four or five bloodlettings in
the course of an acute attack, in each one of which opera-
tions from three to four pounds of blood should, as he
believed, be abstracted. Indeed, he claimed that in an
extreme case it might be perfectly proper to abstract as
much as seventeen pounds (l). Inasmuch as Botallo 's
practice was largely confined to the strong soldiers of
Northern Italy it is easier to understand how such extrava-
gant bloodletting did not more often prove fatal than it
did. When, soon afterward, the Paris Faculty condemned
the practice in the strongest possible terms, Botallo 's
followers characterized sarcastically the French physicians
as ''pigmy bloodletters" {petits saigneurs).

But the efforts of Scribonius, Botallo and others to put
an end to the uroscopy scandal were — I fully believe —
not the only or perhaps even the most potent factors in

414 GROWTH OF MEDICINE

bringing about the suppression of the evil. As many of
our readers will remember, the art collections of European
capitals contain admirably painted specimens of Dutch and
Flemish genre pictures representing every phase of this
uroscopic fraud, and these striking masterpieces, revealing,
as they undoubtedly did to the community at large, the
ridiculous character of the claims made by the charlatans,
could scarcely have failed to give a deadly blow to the
fraud. (See Fig. 17.)

In the early part of the sixteenth century Jean Fernel
of Amiens (1497-1558) was one of the leading medical
authorities of France. After receiving his degree of
Doctor of Medicine at Paris, in 1530, he settled in that city
and soon acquired considerable reputation, not only as a
practitioner but also as a lecturer. In 1545 he was called
upon to take charge, professionally, of Diane de Poitiers,
the mistress of Henry, the son of Francis the First, King
of France. About the same time he was asked to serve as
First Physician to the Dauphin, but he was not disposed
to accept the latter position, as he disliked the duties of
the office and also because he feared that they would inter-
fere with his favorite studies. He pleaded poor health,
and his excuse was accepted as valid. That Fernel was
held in very high esteem by the royal family is evident
from the events which succeeded this refusal. In the first
place, it was insisted that he should accept the stipend
(600 livres) attached to the office, as a mark of the royal
favor; and then, in 1547, when Henry was crowned king
(Henry the Second), Fernel was urged to become his First
Physician; but again he declined the honor, this time on
the ground that Louis de Bourges, who had held the position
with great credit under Francis the First (Henry's father),
was entitled to be retained in office. The King yielded to
Fernel 's generous intervention in behalf of de Bourges.
But in 1556, when the latter died, Fernel felt obliged to
accept the position which had then become vacant; and
from that time forward, until the time of his death on
April 26, 1558, he accompanied the King on all his military
expeditions. As he did not possess a robust constitution,

SOME LEADERS IN MEDICINE 415

his health suffered not a little from the frequent exposures
to hardships of all sorts to which he was subjected; and,
in addition, during this long period he saw very little of
his wife to whom he was devotedly attached.

Fernel is universally admittedHby French physicians to
have been one of the most cultivated teachers and prac-
titioners of medicine of his day. He was a very clear writer,
and would doubtless have made a number of valuable
additions to the science if he had not been carried off by
illness at a comparatively early age.

Of his published writings the following are reckoned the
most important: ^^Universa medicina/^ Paris, 1567; ^^De
abditis rerum causis,^^ Paris, 1548, and ^^ Therapeutic es
universalis seu medendi rationis libri VII. ,^^ Paris, 1554.
(Many editions of each of these works were published.)

In his discussion of various questions relating to physi-
ology Fernel maintains that the component elements of the
body are vivified by means of heat, and he elaborates this
idea very much in the same manner as Hippocrates does
that of the ' ' callidum innatum. ' ' The spiritual life, he says,
is presided over by the soul {^'anima^^). When he comes,
however, to consider the individual powers of the soul,
Fernel treats the subject exactly as does Galen, He gives
expression to one rather bright idea: ''The specific
functions of each of the different organs may be inferred
in large measure from the character of the structural
elements of which they are composed."

In his scheme of pathology Fernel divides diseases into
simple {^'similares*') — diseases of the tissues; compound
{^^organicV) — diseases involving entire organs; and
complicated {^' communes^') — diseases in which the normal
relations between the different parts are broken up.

In the chapter which Fernel devotes to the subject of
therapeutics, there is a section relating to venesection
which, according to Haeser, is well worth reading, as it
reveals the power of the writer to grasp the leading points
and to reason correctly from them.

Two English Physicians Who Became Famous During
the Sixteenth Century. — In the early part of the sixteenth

416 GROWTH OF MEDICINE

century the medical profession of Great Britain was in a
most unsatisfactory state. Humbuggery, ignorance and
superstition were at that period of time the most prominent
characteristics of the majority of physicians upon whom
the people at large had to depend for the relief or cure of
their bodily ailments, and there were very few and very
untrustworthy measures in force for the production of a
better class of practitioners. Just at this juncture there
appeared on the scene a man who was eminently well
equipped to rescue England from this lamentable state of
affairs and to put her on the high road to the acquisition of
an honorable body of medical men and of a corps of
apothecaries who could be trusted to dispense pure drugs
properly compounded. I refer to Thomas Linacre, who
was born at Canterbury in 1461 or 1462, was a Fellow of
All Souls College, Oxford, and a graduate of the University
of Padua, and whose biography is sketched by John Freind
(1675-1728) in such an admirably clear, concise and appre-
ciative manner that I cannot do better — in view of the great
importance of this event in the history of medicine in
England — than to reproduce it here in considerable fulness
of detail.

Thomas Linacre was a man of a bright genius and a clear under-
standing, as well as unusual knowledge in different parts of learn-
ing: and, being very desirous to make further improve-
ments by travelling, he thought he could no where succeed in his
designs so well as by going to Italy, which began then to be famous
for reviving the ancient Greek and Roman learning. There he
was treated with extraordinary kindness by Lorenzo de Medicis,
one of the politest men in his age and a great patron of letters;
who favoured him so far in his studies as to give him the privilege
of having the same preceptors with his own sons. Linacre knew
how to make all his advantages of so lucky an opportunity; and
accordingly, by the instructions of Demetrius Chalcondylas, a
native of Greece, he acquired a perfect knowledge of the Greek
tongue; and so far improved under his Latin master Politian, as
to arrive to a greater correctness of style than even Politian
himself

Having laid in such an uncommon stock of learning, he applied
himself to the study of natural philosophy and physick; particu-

SOME LEADERS IN MEDICINE 417

larly he made it his business, and was the first Englishman who
ever did so, to be well acquainted with the original works of
Aristotle and Galen. He translated ~and published several tracts
of the latter

In his own Faculty he distinguished himself so much that, soon
after his return, he was pitched upon by that wise king, Henry the
Seventh, as t|ie fittest person to be placed about Prince Arthur,
and to take care both of his health and his education. He was
afterward made successively Physician to that king, to his suc-
cessor Henry the Eighth, and to the Princess Mary And

indeed, as he was perfectly skilled himself in his own art, so he
always shewed a remarkable kindness for all those who bent their
studies that way; and wherever he found, in young students, any
ingenuity, learning, modesty, good manners, and a desire to excel,
he assisted them with his advice, his interest, and his purse. And
to give a still stronger proof, how much he had the good of his
own Profession and that of the Publick at heart, he founded two
Lectures of Physick in Oxford, and one at Cambridge

But he had still further views for the advantage of our Profes-
sion: he saw in how low a condition the practice of Physick then
was, that it was mostly engrossed by illiterate monks and empiricks,
who in an infamous manner imposed on the Publick ; the Bishop of
London or the Dean of St. Paul's for the time being, having the
chief power in approving and admitting the practitioners in
London, and the rest of the bishops in their several dioceses. And
he found that there was no way left of redressing this grievance,
but by giving encouragement to men of reputation and learning,
and placing this power of licensing in more proper hands. Upon
these motives he projected the foundations of our College [of
Physicians] ; and using his interest at Court, particularly with
that great patriot and munificent promoter of all learning, Cardinal
Woolsey, he procured Letters Patent from the King, which were
confirmed by Parliament, to establish a corporate Society of
Physicians in this city, by virtue of which authority the College,
as a corporation, now enjoys the sole privilege of admitting all
persons whatever to the practice of physick, as well as that of
supervising all prescriptions. And it is expressly declared that
no one shall be admitted to exercise physick in any of the dioceses
in England, out of London, till such time that he be examined by
the President and three of the Elects, and have letters testimonial
from them, unless he be a graduate in either University, who, as
such, by his very Degree, has a right to practice all over England,

418 GROWTH OF MEDICINE

except within seven miles of London, without being obliged to
take any license from the Bishop

By other Acts another weighty affair is committed to the care
of the College, [viz.,] the visiting of shops and the inspection of
medicines; a thing surely of as much consequence at least to the
patient as to the prescriber

Linacre was the first president of his new-erected college, and

held that office for the seven years he lived after And

perhaps no Founder ever had the good fortune to have his designs
succeed more to his wish ; this society has constantly produced one
sett of men after another, who have done both credit and service
to their country by their practice and their writings.

If further evidence be needed to show what was the type
of mind possessed by this remarkable English physician,
I may be permitted to quote here a single brief statement
made by his friend Erasmus, the famous Dutch scholar
and theologian, in a letter addressed to John Fisher,
Chancellor of Cambridge University: ''Linacre is as deep
and acute a thinker as I have ever met with. ' '

In England, during the seventeenth century, there ap-
peared on the scene only one practicing physician of such
conspicuous ability and of so marked personal traits of
character as to place his name, after the lapse of a few
years from the time of his death, and by the almost
unanimous assent of his associates, high up on the roll of
honor. I refer to the famous physician Sydenham.

Thomas Sydenham was born at Wynford Eagle, Dorset-
shire, England, in 1624. At the age of eighteen he entered
Magdalen College, Oxford, and remained there until 1644,
when he enlisted in the Parliamentary Army. After a
brief military service, he resumed his studies at the univer-
sity and received his Bachelor's degree in 1648. It was
only at a much later date (1676), however, that he was
given (after he had pursued the prescribed course of
studies) the degree of Doctor of Medicine, — and then not
by Oxford, but by Cambridge. After leaving the university
he first spent a few months at the Medical School of
Montpellier, France, and then settled (1666) in London as
a practicing physician, the necessary license having been

t/?^-

FIG. 17. THOMAS SYDENHAM.
(After the portrait in the hall of All Souls' College, Oxford.)

SOME LEADERS IN MEDICINE 419

granted him by the College of Physicians. His first med-
ical treatise, which bore the title '^Methodus Curandi
Febres^^ [Method of Treating Fevers], was published in
1666. The third edition of this work was issued ten years
later, but with the title changed to ^^Observationes Medicae
etc." Between 1666 and 1683 he published several other
treatises, th^ more important of which deal with epidemic
diseases — syphilis, small-pox, hysteria and gout.

During the later period of Sydenham's career he attained
great celebrity as a physician ; but this celebrity would have
been short-lived if it had rested on nothing more sub-
stantial than mere cleverness and professional success.
As a matter of fact he had brought about, by his teaching
and also by his example, a most important revolution in
medicine, and it was the appreciation of this fact which led
the physicians of England to bestow upon him, after his
death, the appellation of ''The English Hippocrates," and
which ultimately gave him so highly honorable a position
in the history of medicine in general. A brief review of
the state of medicine in England during the seventeenth
century will enable the reader to understand the full
importance of the change which Sydenham was instrumental
in bringing about.

The physicians of that period were split up into three
sects : the followers of Galen, with whom should be classed
the Graeco-Arabists ; the iatrochemists ; and the iatro-
physicists.

The Galenists were largely intent upon the strictest
interpretation of the teachings of Hippocrates, Galen and
some of the Arabian authors. Instead of studying disease
itself they devoted their time and thoughts largely to the
interpretation of the words used by these fathers in medi-
cine— i.e., to philology. Real progress in the science of
medicine was not possible along this route. Accepting
without dispute the dogma of the four humoral qualities,
together with the different temperaments which result
from the predominance of any one of them, they combated
these different temperaments or constitutions by pre-

420 GROWTH OF MEDICINE

scribing drugs in a very great variety of combinations
(polypharmacy) .

The iatrochemists, attaching small importance to simple
dietetic measures, prescribed without stint all the most
active substances belonging to the mineral kingdom and all
the new remedies which the chemists had evolved from their
furnaces.

Finally, the iatrophysicists directed their efforts to the
removal or diminution of all bodily conditions that appeared
to act as mechanical hindrances to health.

Sydenham, who possessed a rare degree of common
sense, cast aside all these hypotheses, disregarded the
prevailing routine methods of treatment, and refused to
accept the therapeutic novelties of the day. ''Nature is
to be my guide," he declared, and from that time forward
he studied disease at the bedside, and watched carefully,
and with a mind free from prejudice, the effects of the
remedies which he employed. Thus, pursuing the methods
advocated by the great master Hippocrates, he was able
to place his medical brethren once more on the pathway
which leads to an increase in knowledge of the healing art.
Practical medicine, which had previously been falling into
an almost moribund condition, was by his efforts made
again a living and growing science. That Sydenham had
a perfectly clear conception of what was needed at that
time to renew the vitality of the medical profession of
England is plainly shown by the following statement which
he makes in the dedication of one of his writings to Dr.
Mapletoft:— ^

After studying medicine for a few years at the University of
Oxford, I returned to London and entered upon the practice of
my profession. As I devoted myself with all possible zeal to the
work in hand it was not long before I realized thoroughly that the
best way of increasing one's knowledge of medicine is to begin
applying, in actual practice, such principles as one may already
have acquired; and thus I became convinced that the physician

1 Translated from the French version printed by Daremberg in his Histoire
de la Medecine, Vol. II, p. 706. The originals of Sydenham's writings are all
in Latin.

SOME LEADERS IN MEDICINE 421

who earnestly studies, with his own, eyes, — and not through the
medium of books, — the natural phenomena of the different diseases,
must necessarily excel in the art of discovering what, in any given
case, are the true indications as to the remedial measures that
should be employed. This was the method in which I placed my
entire faith, being fully persuaded that if I took Nature for my
guide I shoul4 never stray far from the right road, even if from
time to time I might find myself traversing ground that was wholly
new to me.

In the brief account which I have thus far given of the
part played by Sydenham in advancing the science of
medicine, I have called attention only to the general
character of the services which he rendered. It may now
be interesting to furnish here a few details that will aid
in completing the picture of this great English physician, —
details relating to his life and personal character, to his
views regarding certain diseases and the remedies which
he was in the habit of employing for their relief or cure,
and to his later writings.

Throughout the greater part of his professional career
Sydenham was a frequent sufferer from gout, some of the
attacks being of a severe type and occasionally of long
duration. During the winter of 1676, for example, he was
seriously ill from renal calculus, haematuria being brought
on by the slightest movements of his body. All through
the year 1677 he continued to experience frequent attacks
of pain, and on one occasion he was unable to leave the
house for a period of three months.

Speaking of the epidemic of the Plague in 1665, during
the progress of which he left London, Sydenham says:
''When I saw that the danger was in my immediate neigh-
borhood I listened to the advice of my friends and joined
the crowd of those who were fleeing to the country. A
little later, when the epidemic had further increased in
severity, and before any of my neighbors had returned, I
yielded to the calls of those who had need of my services,
and went back to London." It is worthy of remark, says
Laboulbene, who fully appreciated the heroism which
prompted this last decision, that we should never have

422 GROWTH OF MEDICINE

known of Sydenham's weakness in regard to facing his
duty, if he himself had not stated the facts. This famous
epidemic, as is well known, was accompanied by an appalling
mortality.

Andrew Browne, a Scotch physician of good standing,
entertained serious objections to some of the advice given
by Sydenham in the treatise entitled ^^Schedula monitoria
de novae febris ingressu,^'^ and, in order to learn more
precisely what the author's views on the subject really
were, he decided to run down to London for a day or two.
Sydenham gave him such a cordial reception and made his
stay in the metropolis so pleasant that he remained there
several months — instead of a day or two. ''And when I
returned to Scotland I felt contented and joyful as if I
were carrying back with me a valuable treasure. ' '

As an instance of his thoughtful kindness, it is related
that Sydenham had occasion to treat a poor man who lived
in his neighborhood for an obstinate bilious colic, but his
employment of narcotics did not effect very much in the
way of relief. *'I felt moved by pity for this poor man in
his misery; and accordingly I loaned one of my horses to
him in order that he might take long excursions on horse-
back."

Sydenham had no eagerness for professional honors,
although he appreciated highly those which came to him
spontaneously. As already stated at the beginning of this
sketch, the degree of Doctor of Medicine was not conferred
upon him by Cambridge as a mere honorary affair, but was
won by him after he had passed through the regular course
of training required of all candidates for this degree. His
case, however, was peculiar in one respect : he waited until
after he had been in active practice several years before
he decided to pass through the course of training required.
He was not a member of the College of Physicians of
London, and he held no official position at Court.

The following summary may serve to convey some idea
of Sydenham's views regarding pathology and treatment.

2 Pronounced by Haeser to be a compilation, and not one of Sydenham 's
genuine writings.

SOME LEADERS IN MEDICINE 423

He defines an acute disease as **a helpful effort made by
Nature to drive out of the body or system, in every way
possible, the morbific material. ' ' As regards the latter he
makes the following remarks : —

Certain diseases are caused by particles which are disseminated
throughout the atmosphere, which possess qualities that are
antagonistic ^to the humors of the body, and which — when once
they gain an entrance into the system — become mingled with the
blood and thus are distributed throughout the entire organism.
Certain other diseases owe their origin to fermentations or putre-
factions of the humors, which fermentations vary in their nature —
in some cases the humors being excessive in quantity, while in
others they are bad in quality; and in either event the body finds
itself incapable of first assimilating them and then excreting them —
a state of affairs which cannot continue beyond a certain length
of time without producing further harmful effects.

According to Sydenham the fever, in the acute diseases,
assists Nature by separating from the general (total) mass
of the blood those particles which have undergone putre-
faction or have been rendered unassimilable. Then they
are driven out of the body by the route of the sweat-glands,
by diarrhoea, by eruptions upon the skin, etc. On the other
hand, in chronic diseases the morbific material is not of
such a nature as to produce fever, which is a mechanism
for securing complete purification. It is therefore deposited
in one part or another of the body where no force exists
which is capable of ejecting it; or its final transformation
is not completed until after the lapse of a long period of
time.

In some of Sydenham's writings one is occasionally
surprised to find teachings which seem to be strongly at
variance with the advice which he was so fond of giving —
namely, that physicians should be careful not to set up
hypotheses which are not based upon observed facts. A
conspicuous instance of such a disregard of his own rule
may be found in his setting up of a pathological process to
which he gives the name of "inflammation of the blood."
This process, he maintains, is the active cause of quite a
large number of diseases, especially those of an epidemic

424 GROWTH OF MEDICINE

nature — such, for example, as pleurisy, pneumonia, rheu-
matism, erysipelas, scarlet fever, etc. It is well-nigh
impossible for us moderns to comprehend how so practical
and clear-headed a man as Sydenham could have formulated
such a purely hypothetical pathology, a doctrine so com-
pletely lacking in anything like a solid foundation of fact.

Sydenham excelled in the description of the clinical
manifestations of certain diseases, as, for example, small-
pox, hysterical affections, the encystment of a renal
calculus, and the gout — a disease from which, as already
stated, he was a very frequent sufferer throughout a large
portion of his life. All his published works are in the Latin
language, but translations have been made into English,
French, German, Flemish and Italian. At All Souls College,
Oxford, where Sydenham spent eight years of his life, it
was a fixed rule that all its members should habitually
converse and write in Latin.

Sydenham's remarks upon liquid laudanum are worth
recording : —

Of all the remedies which a kind Providence has bestowed upon
mankind for the purpose of lightening its miseries there is not one
which equals opium in its power to moderate the violence of so

many maladies and even to cure some of them Medicine

would be a one-arm man if it did not possess this remedy

Laudanum is the best of all the cordials; indeed, it is the only
genuine cordial that we possess to-day. [This was written in the
middle of the seventeenth century.]

The laudanum employed by Sydenham was made accord-
ing to the following formula : Spanish wine, 400 grammes ;
Opium, 62 grammes; Saffron, 31 grammes; Powder of
Canella and Powder of Clove, of each 4 grammes.

After much suffering and extreme weakness, Sydenham
died on December 31, 1689.

Andrew Browne, the Scotch physician of whom mention
has already been made on an earlier page, makes the
following comments on the closing days of Sydenham's
career: *'It is a difficult matter to believe, and yet it is
the truth: This great physician, who throughout his life

SOME LEADERS IN MEDICINE 425

gave the clearest proof of nobility of soul, generosity and
clear-sightedness, died with the accusation hanging over
his head that he was 'an impostor and an assassin of
humanity.' " Laboulbene adds: ''After years of self-
sacrifice in behalf of his fellow men Sydenham received as
his final earthly reward calumny and ignominy, and the
jealousy of many professional brethren."

CHAPTER XXXIII

THE THREE LEADING PHYSICIANS OF GERMANY
DURING THE LATTER HALF OF THE SEVEN-
TEENTH CENTURY: FRANZ DE LE BOE SYL-
VIUS, FRIEDRICH HOFFMANN AND GEORG
ERNST STAHL

The seventeenth century, says Berendes, was one of the
saddest periods in the history of Germany ; but, during the
greater part of this time, the neighboring countries —
Holland, France, England and Italy — still continued to
enjoy many of the blessings of the Renaissance, — such, for
example, as an uninterrupted activity of artistic efforts,
of scientific work, and of commerce; — ^but in Germany
everything seemed to be in a state of confusion. A bloody
religious war was at this period devastating the land, and
the best powers of the people were being wasted. Instead
of increasing cultivation of manners and sentiments, there
was a steady growth of savagery. The Protestants,
although they probably were numerically superior, were
split up into factions. The Catholics, on the other hand,
were united, and their power steadily increased. In
1618 the disturbances, which previously had been scattered
in character, took on the form of what in time came to be
known as *'The Thirty Years' War," a struggle which
proved to be most sanguinary, costing Germany a great deal
in every respect. Finally, the war was brought to an end
by the signing of the Westphalian Treaty of Peace at
Liitzen, in 1648. Some idea of the terribly destructive
nature of this long war may be gathered from the fact that
the population of Germany, which previously had been

LEADING PHYSICIANS OF GERMANY 427

estimated at twenty millions, was found to have been
reduced to about six millions. Whole towns and villages
were laid in ashes, and as a consequence those who had
survived the disaster lost confidence in themselves and
were not able, at least for several years, to undertake
anything in art, literature or science ; and this depressing
atmosphere affected in some degree the people of the
Netherlands. Toward the end of the century, however,
there came a marked awakening among the younger
generation of physicians, and in the course of twenty or
thirty years four men, only three of whom, however, were
of German birth, succeeded in attaining a decided leader-
ship in this department of science. The names of the
Germans are Franz de le Boe (commonly spoken of as
Sylvius), Friedrich Hoffmann and Georg Ernst Stahl. I
shall now attempt to furnish, as nearly as possible in
proper chronological order, very brief sketches of the lives
of these distinguished physicians, together with an account
of the contributions which they made to the science of
medicine.

Franz de le Boe {Sylvius). — Franz de le Boe (Sylvius)
was born at Hanau, Prussia, in 1614, of parents who
belonged to the nobility and were wealthy, and who con-
sequently were able to give their son every opportunity for
acquiring an excellent education. Thus Franz first received
a thorough training in philosophy and the classics and
afterward visited in turn all the leading universities of
Holland, France and Germany before he finally took his
degree of Doctor of Medicine at Basel, Switzerland, in,
1637. From this time forward, for a period of twenty-
three years, he devoted himself to the practice of his
profession, first in his native city and then in Leyden and
Amsterdam. In 1660 he accepted an invitation to occupy
the Chair of Medicine in the University of Leyden, and this
position he held during the remainder of his life. He died
in 1672.

As a teacher Sylvius was very popular, Boerhaave alone,
at a later period, finding greater favor among the crowds
of medical students and physicians who frequented this

428 GROWTH OF MEDICINE

university. Haeser and Haller both attribute some portion
of this popularity to the fact that Sylvius combined genuine
eloquence with a wonderful charm of manner and a pro-
found knowledge of chemistry, pharmacy and pathological
anatomy. In the practice of medicine he followed Van
Helmont very closely, but he was not willing to accept his
teachings about an ^'archaeus insitus^^ and an ^^archaeus
influus.'* The system which he advocated was of a very
simple character, and this fact undoubtedly contributed
much to his popularity among the students. His thera-
peutic methods were also of a thoroughly practical nature.

Of the works which Sylvius published the following
deserve to receive special mention: ^'Disputationes med-
icae," a book in which are set forth his views regarding the
fundamental principles of the science of medicine — ^physi-
ology in particular; *'Z)e methodo medendi,^^ a treatise on
therapeutics; and ^^Praxeos medicae idea nova/^ a new
idea concerning the practice of medicine.

Sylvius was one of the earliest defenders of Harvey's
great discovery, and he was also one of the first to call
attention to the part played by chemistry in elucidating
some of the problems in physiology and pathology. At the
same time he was always ready to acknowledge the impor- i
tance of the part played by mechanics in respiration, in the
circulation of the blood, in the movements of the intestines,
etc., in which respects he was in entire agreement with the
iatrophysicists or iatromathematicians.^

Finally, there is one more respect in which Sylvius is
entitled to great credit: he paid most careful attention to
the work of giving clinical instruction. Recognizing, as I
do, the importance of this branch of medicine, I shall not
hesitate to devote here a page or two to a brief review of
the manner in which it came to hold the honorable position
which it occupies to-day in all the best schemes for medical
education.

During the sixteenth century, as Puschmann assures us,
an attempt was made at Padua, Italy, to render clinical

1 Physicians who maintain that all physiological and pathological phenomena
may be explained by the laws of physics.

LEADING PHYSICIANS OF GERMANY 429

instruction an essential part of the physician's education,
but the difficulties which were encountered proved so much
greater than was anticipated that it was soon found
necessary to abandon the plan; and then for many years
no further effort was made, either at Padua or at any of
the other Italian medical schools, to introduce clinical
teaching. After the lapse of nearly a century, Johannes
Heurnius (1543-1601), Professor of Medicine at the Uni-
versity of Leyden, made an effort to introduce the plan of
teaching medicine at the bedside; and a few years later
(1630) two other professors of the same university — viz.,
Otho Heurnius, son of Johannes, and E. Schrevelius —
formally introduced clinical instruction at the city hospital.
The plan which they adopted was the following: The
students in turn were permitted first to question the patient
about his ailment and then afterward to make whatever
physical examination appeared to be necessary; next, each
one of them stated briefly what he believed to be the nature
of the malady, and also gave his views as to the prognosis,
symptoms and treatment; after which the professor com-
mented on these different reports, pointing out both the
correct and the incorrect features in each case. After a
short trial of the plan it became clear that it would have
to be abandoned, for the students did not like to have
attention called in such a public manner to their mistakes.
Then, a few years later, Sylvius, who at that time was the
Professor of Medicine, introduced a system of clinical
teaching which is thus briefly described by his colleague,
Lucas Schacht: —

When, followed by his pupils, he approached th*e bedside of a
patient, he assumed the air of one who is entirely ignorant of
the nature of that person 's malady, of the accompanying symptoms,
and of the treatment which was being carried out. Then he began
to ask first one and then another of the students a great variety
of questions respecting the case that was under consideration, —
questions which at first seemed to have been propounded in a
haphazard fashion, but which in reality were so cleverly formu-
lated as to elicit from the class all the information needed for the
making of a correct diagnosis, while leaving on the minds of the

430 GROWTH OF MEDICINE

students the impression that they, and not the professor, had
worked out the problem to a successful result.

This system, if such it may be termed, proved extremely
successful, and the knowledge of this success spread
rapidly from one end of Europe to the other, causing
students and physicians to flock to Leyden from Eussia,
Poland, Hungary, Germany, Denmark, Sweden, France,
Italy and England. So long as this particular university
continued to possess, as a member of its faculty, a pro-
fessor of medicine who was clever enough to carry on
clinical instruction with the same profound knowledge of
human nature as had been displayed by Sylvius, just so
long did this institution remain without a rival in this part
of the field of medical education. Then Sylvius was
followed, in the work of clinical teaching, by Boerhaave,
a man admirably fitted, both by nature and by the training
which he had received, to keep the University of Leyden
in the first rank of medical schools as regards this most
useful form of discipline. After 1738, the year in which
Boerhaave died, other universities besides that of Leyden
began to provide fairly satisfactory facilities for clinical
study, and among the number of such institutions those of
Utrecht, Eome, Edinburgh, Paris and Halle deserve to be
mentioned. The lack of funds and doubtless also the lack
of the right sort of teachers were the principal reasons why
these schools were not able to vie with Leyden in furnishing
the facilities needed for clinical instruction. That the
fault — at least in the case of the University of Halle — was
not to be attributed to a failure on the part of the Medical
Faculty to appreciate the value of such instruction is
clearly shown b^ the saying attributed to Friedrich Hoff-
mann, who at that period was the Professor of Medicine : —

By a mere attendance upon medical lectures no man will ever
succeed in becoming a properly equipped practitioner of that art ;
it is indispensable, in addition, jthat he should receive clinical
instruction.

The fairly permanent establishment of this fundamental
branch of medical teaching was not effected until about the

LEADING PHYSICIANS OF GERMANY 431

middle of the eighteenth century, when Van Swieten, one
of Boerhaave's most distinguished pupils, was given full
authority by the Empress Maria Theresa to furnish, at
the University of Vienna, all the facilities required for
successfully carrying on such instruction. From that time
onward, to a quite recent date, Vienna has been the Mecca
of all the younger physicians who aspired to become fully
equipped in the practical branches of the science of
medicine.

Georg Ernst Stahl. — Georg Ernst Stahl was born at
Anspach, Germany, in 1660. Little is known about his
early life beyond the fact that he pursued his studies at the
University of Jena, received the degree of Doctor of
Medicine from that institution in 1684, and shortly after-
ward began giving private courses in medicine which
proved to be very popular and soon brought him into
public notice. In 1687 he was given the position of Court
Physician at Weimar. In 1694, upon the recommendation
of Friedrich Hoffmann, who was at that time the incumbent
of the regular Chair, he was appointed Associate Professor
of Medicine in the recently founded University of Halle,
Prussian Saxony; the understanding being that he was to
devote his attention more particularly to the physiological,
pathological, chemical and botanical aspects of the subject.
He held this position up to the year 1716, when he was
appointed one of the attending physicians of Frederick
William the First, King of Prussia, and thereafter was
obliged to reside in Berlin, in which city he died in 1734.

Stahl was a tireless worker, and wrote a large number
of treatises (two hundred and forty-four in all) on physi-
ological and pathological topics — all of them in Latin.
Albert Lemoine, who has written an elaborate monograph
on one of these treatises (that relating to anim\sm), says
that, despite the obscure style in which this and most of his
other treatises are written, one may, upon careful study,
satisfy himself that Stahl is a very close reasoner and
possesses a clear mind. His most conspicuous faults,
Lemoine adds, are these: he is opinionated and vain, and
objects strongly to any criticisms that his opponents make ;

432 GROWTH OF MEDICINE

and yet he is careful to take up these criticisms one by one
and subject them to a close analysis. His vanity led him to
maintain that he was the only person then living who was
capable of lifting medicine out of the rut in which it was at
that time rigidly held. He manifested a sovereign contempt,
not only for the men whose opinions differed from his, but
also for those who complained of the difficulty of com-
prehending the Latin in which his treatises are written.
Finally, Lemoine states that Stahl is addicted to mysticism,
as is shown by the invocations of all sorts with which he
begins and ends most of his writings. Haeser adds that
Stahl possessed a gloomy, reticent and overbearing spirit,
in striking contrast with the charming sweetness of temper
of his colleague Hoffmann.

Among Stahl 's numerous contributions to medical liter-
ature there is only one in which our readers are likely to
take any particular interest; I refer to the treatise which
bears the title "Theoria medica vera^^ — the true theory
upon which the science of medicine is based. It is in this
work more particularly that Stahl expounds the doctrine
of animism. As I have tried in vain to obtain a really
satisfactory conception of this doctrine, which occupied so
great a place in the thoughts of the physicians of the period
between 1650 and 1750, 1 have decided to rest satisfied with
merely reproducing here the interpretation which William
Cullen of Edinburgh, one of Stahl 's contemporaries and
also one of the greatest English physicians of that period,
gives in his celebrated *' First Lines of the Practice of
Physic": —

What is frequently spoken of as the power of nature — the ''vis
conservatrix et medicatrix naturae'' — resides entirely in the
rational soul. Stahl supposes that upon many occasions the soul
acts independently of the body, and that, without any physical
necessity arising from that state, the soul, purely in consequence
of its intelligence, perceiving the tendency of noxious powers
threatening, or of disorders any ways arising in the system, imme-
diately excites such motions in the body as are suited to obviate
the hurtful or pernicious consequences which might otherwise take
place.

LEADING PHYSICIANS OF GERMANY 433

Barthelemy St. Hilaire of Paris (1805-1895) in one of his
writings says: **I am convinced that the central idea in
Stahl's physiology was suggested to him by the reading
of Aristotle's ^De anima,^ in which this great philosopher
states that the soul nourishes the body, and also that
nutrition is one of the four ways in which the soul manifests
itself."

Speaking of the effect of Stahl's doctrines upon the
actual practice of medicine as a whole, Cullen says that it
was of a controlling character, leading physicians to
propose the **art of curing by expectation"; the natural
result of which was that they advocated for the most part
the employment of only very inert and frivolous remedies.
On the other hand, they zealously opposed the use of
some of the most efficacious drugs, such as opium and the
Peruvian bark, and resorted to bleeding and to the
administration of emetics only in exceptional cases. Cullen
adds that: —

The Stahlian system has often had a very baneful influence on
the practice of physic, as either leading physicians into, or con-
tinuing them in, a weak and feeble practice, and at the same time

superseding or discouraging all the attempts of art The

opposition to chemical medicines in the sixteenth and seventeenth
centuries, and the noted condemnation of antimony by the Medical
Faculty of Paris, are to be attributed chiefly to those prejudices
which the physicians of France did not entirely get the better of
for near a hundred years after. We may take notice of the reserve
it produced in Boerhaave with respect to the use of the Peruvian
bark.

Stahl, after taking up his residence in Berlin, devoted
himself energetically to the increase and spread of the
knowledge of chemistry. The thing which brought him the
greatest celebrity, both in his own lifetime and also during
the years following his death, was his propounding of the
'* phlogiston" theory. This theory was to the effect that
all combustible materials or substances contain (as he
assumed) an element to which he gave the name of
phlogiston. He was not able, however, to demonstrate the
actual existence of this element; he simply assumed that

434 GROWTH OF MEDICINE

it existed. At the same time the fact should here be stated
that the terms ''oxidation" and ''reduction," which came
into use during the following century, developed out of this
theory of phlogiston.

Friedrich Hoffmann. — Friedrich Hoffmann was born at
Halle, Prussian Saxony, February 19, 1660, and received
his medical education in his native city, largely under the
direction of his father, who was himself a physician. In
1678 he attended lectures at the University of Jena, and
in the following year visited Erfurt in order to benefit from
the instruction of Caspar Cramer, who was at that time
a distinguished authority in chemistry. At the end of two
years he returned to Jena, took his degree of Doctor of
Medicine, and acquired the right to deliver public lectures.
Then, during the following three years, he visited Holland
and England, and, upon his return in 1685, settled at
Minden, Westphalia, as a general practitioner of medicine.
In 1686 he was appointed District Physician of the Princi-
pality of Minden and also Court Physician of the Prince
Elector; and two years later he accepted the position of
District Physician at Halberstadt. After the inauguration
of the new university at Halle, July 12, 1694, Hoffmann
appears as one of the earliest professors chosen to serve the
institution. In 1701, when Frederick the Third, Electoral
Prince of Prussia, assumed the crown under the title of
Frederick the First, King of Prussia, he extended to Hoff-
mann an invitation to come to Berlin and accept the
position of Private Physician to His Majesty. Hoffmann
was not at first willing to accept the invitation, but in 1708,
when the King, who had then become seriously ill, renewed
his request, Hoffmann accepted, on condition that he might
retain his professorship. In 1712 he returned to Halle and
remained there until he died in 1742.

Before Hoffmann's time very little was known concerning
the nature of carbonous (or carbonic) oxide and concerning
the fatal effects which may be produced by inhalation of
this gas. It was a common belief, for example, that the gas
was given off by freshly plastered walls ; and — as an even
worse error — the theological authorities showed an incli-

LEADING PHYSICIANS OF GERMANY 435

nation, in many of the fatal instances which probably were
due to inhalation of carbonous oxide, but in which no
recognizable cause of death had been discovered, to explain
the event as due to the malign interference of the Devil.
In our time it is well understood in the community that the
fumes of carbonous oxide constitute the most dangerous
gas that one is liable to encounter, but in Hoffmann's day
the people appear to have been less well informed concern-
ing this danger than they were in ancient times. In the
treatise on this subject which Hoffmann published in 1716,^
several of the earliest known instances of such poisoning
are narrated, the first one being that mentioned very briefly
by Aristotle (384-322 B. C). Then follow two very short
references to this subject in the *'Z)e rerum natura^^ of the
Roman poet Titus Lucretius Cams (95-52 B. C). They
read as follows: (1) **The fumes of burning charcoal
easily aifect the brain if thou hast not first taken a drink
of water." (Book VL, verse 803.) (2) ''If the fumes of
the night lamp,^ after it has been extinguished, are inhaled
rather deeply the effect experienced will be the same as if
one had been struck down by a blow on the head." (Book
VI., verse 792.) The idea that the previous drinking of
water is competent to prevent the effects of poisoning by
charcoal fumes is declared by Neuburger, the translator
of Hoffmann's treatise, to be erroneous.

The earliest really satisfactory description of an instance
of non-fatal poisoning by the fumes of burning charcoal is
credited by Hoffmann to the Roman Emperor, Julian the
Apostate, who reigned from 361 A. D. to 363 A. D. Before
he was made Emperor, Julian was intrusted by Constantius
II., in 355 A. D., with the government of the Province of
Gaul, and in 357 he won a great battle against the Alamanni
at Strassburg; after which he took up his residence in the
little city of Lutetia, the present Paris. It was undoubtedly

2 ' ' Griindliches Bedenken und physicalische Anmerkungen von dem todt-
lichen Damff der Holzkohlen," Halle, 1716.

8 Probably this refers simply to a brazier containing burning charcoal, the
light emitted by which would doubtless be sufficient to answer the purpose of a
night lamp.

/

436 GROWTH OF MEDICINE

soon after this event that he wrote the Greek satire which
bears the title *'Misopogon," and from which Hoffmann
quotes the following account of Julian's narrow escape
from death through the poisonous effects of carbonous
oxide : —

The little city which the Celts call Lutetia is built upon a small
island in the midst of a river, and access to it from both sides is
gained by means of wooden bridges. Ordinarily the winter climate
in this region is mild, owing — as the people of the place claim —
to the proximity of the Ocean. Good wine is produced there, and
even fig-trees flourish provided care be taken to wrap them well
in wheat straw or some similar protective material during the winter
season. But my visit happened to have been made during an
exceptionally severe winter, and as a result things which looked
like slabs of Phrygian marble, closely packed together, were con-
stantly floating down the river with the current, and, soon becoming
jammed, they formed a sort of natural bridge. Although most of
the houses — the one I occupied among the number — were provided
with fireplaces and chimney-flues, and might therefore readily be
heated, I was not willing that a fire should be kindled in my
bedroom. I wa§ very little sensitive to cold, and, in addition, I
was desirous of becoming more and more hardened to its influence.

As the severity of the weather, however, showed no signs

of letting up, I permitted the attendants to bring into the room
a few glowing coals, just enough to render the air of the chamber
less chilly. But, notwithstanding the very small degree of heat
which these few burning coals supplied, it proved to be sufficient
to draw out from the damp walls exhalations that caused my head
to feel as if it were tightly held in a vice and also produced a
sensation as if I were choking. I was immediately removed from
the room, and the physicians who were promptly summoned
administered an emetic which enabled me to get rid of the food
which I had eaten a short time before. Soon afterward I had a
refreshing sleep and was able on the following day to resume my
work as usual. [Translated from the German version printed in
Neuburger 's monograph. ]

As will be seen from the reports which I have just quoted,
there existed among the Germans, early in the eighteenth
century, no fixed belief as to the real cause of death in many
of these unexplained fatal cases; and it was therefore no

LEADING PHYSICIANS OF GERMANY 437

small public service which Hoffmann rendered when he,
in whose judgment about such matters the people at large
placed the greatest confidence, published such a clear and
simple explanation of the real cause of these deaths as that
which is given in this interesting monograph.

Hoffmann also added not a little to his fame by the
invention of a remedy which was first known as '* Hoff-
mann's drops," but which to-day appears in the United
States Pharmacopoeia under the name of ''Hoffmann's
anodyne" or ^^spiritus aetheris compositus^^ (sulphuric
ether, 325; alcohol, 650; ethereal oil, 25).

CHAPTER XXXIV

HERMANN BOERHAAVE OF LEYDEN, HOLLAND,
ONE OF THE MOST DISTINGUISHED PHYSI-
CIANS OF THE SEVENTEENTH CENTURY

Hermann Boerhaave, who was born at Voorhont, near
Ley den, Holland, on December 31, 1668, was the son of a
poor but highly educated clergyman; and it was owing to
this circumstance that he received in early youth a most
careful training in Latin and Greek and in belles-lettres.
At the age of fourteen he entered the public school of
Leyden, and made such rapid progess in his studies —
history, mathematics, the different branches of natural
philosophy, Hebrew and Chaldean languages, and meta-
physics— that he was soon able to follow regularly the
lectures given at the university. He was only fifteen at
the time when his father died, leaving him absolutely
penniless; but Van Alphen, the Burgomaster of Leyden,
befriended him and furnished all the funds needed for a
continuance of his studies at the university. But young
Boerhaave, who was not willing to be entirely dependent
on the aid thus provided, contributed to his own support
not a little by giving private instruction to young students
of the wealthy class. In 1690 he received the degree of
Doctor of Philosophy, the subject of his dissertation being
a refutal of the doctrines of Epicurus, Hobbes and Spinosa.
His original intention had been to prepare himself for the
ministry, but, after continuing his studies in theology for
a short time, he determined that the better course for him
would be to choose the career of physician. Accordingly
he began, at the age of twenty-two, to study the anatomical
treatises of Vesalius, Fallopius and Bartholinus, and at the
same time he followed a course of instruction in dissecting.

HERMANN BO ERE AAV E OF HOLLAND 439

under the guidance of the anatomist Nuck, and also occa-
sionally attended the lectures given by Drelincourt, who
at that time was Professor of the Theory of Medicine. In
his reading of medical literature he showed a decided
preference for the writings of Hippocrates and Sydenham ;
and he devoted a large portion of his time to the study of
botany and chemistry, two branches of the science of medi-
cine in which he took a very strong interest all through
life. In 1693 he received the degree of Doctor of Medicine
from the University of Harderwyk.^ In 1701 he was
appointed Associate Professor of the Theory of Medicine
in the University of Leyden, and it was in this capacity
that he began building up that great reputation which in a
very few years brought crowds of students from all parts
of the world to Leyden. As already stated on a previous
page, he owed a large part of his fame to the admirable
manner in which he conducted his clinical teaching. To
show how widely he was known throughout Europe the
story is told that a letter which had been sent to him from
a mandarin living in China and which bore the address,
*'To the illustrious Boerhaave, Physician in Europe,'*
reached him in due course.

Soon after his first appointment at Leyden, he received
other most flattering offers, such as that of William the
Third, Hereditary Prince of the Netherlands, to accept the
position of Court Physician at The Hague, and a call from
the University of Groningen (1703) to occupy the Chair
of Medicine. He declined these offers as he preferred to
remain at Leyden; but, a few years later, in 1709, he
accepted the full professorship of the Practice of Medicine
in the institution with which he was already connected.
From the vantage ground of this more responsible position
he was able most successfully to teach the students the best
methods of observing, identifying and treating the different
diseases ; and as a further result of this promotion in rank
his private practice grew rapidly, monarchs and princes

1 A small seaport town located on the Zuider Zee, about thirty miles north-
east of Amsterdam. The university, which was founded there in 1648, was
abandoned in 1818.

440 GROWTH OF MEDICINE

coining from every country in Europe to consult him about
their maladies. Boerhaave was also most popular among
his fellow townsmen. It is related of him, for example,
that on one occasion, after he had been confined to the
house for about six months by an illness of a gouty nature,
the citizens of Leyden manifested their joy at his recovery
by inaugurating a general illumination of the town during
the evening of the day on which he made his first appear-
ance on the street. He had two relapses of the gouty
affection, one in 1727 and another in 1729, and he finally
died from disease of the heart on September 23, 1738. The
monument raised in his honor by the city of Leyden bears
the inscription: "Salutifero Boerhaavii genio sacrum'*
(Sacred to the memory of the health-giving genius of
Boerhaave).

Some idea of the lucrative character of Boerhaave 's
private practice may be gained from the fact that he left
to his only child, a daughter, the sum of about four million
francs. And yet he was noted for the generous gifts which
he made during his lifetime to all sorts of scientific and
benevolent objects.

Boerhaave, says Dezeimeris, exercised during his career,
and also for a long time after his death, an immense
influence upon medical thought. He is justly ranked, he
adds, among the iatromathematicians, and it is correct to
say that he was largely instrumental in overthrowing the
chemical system which de le Boe (Sylvius) had developed.
His own treatise on this branch of knowledge (''Elementa
Chemiae"), which was published toward the end of his
life, soon became the standard work on this subject, and
it retained its popularity for many years. *'It is to be
regretted that, possessing as Boerhaave unquestionably
did, remarkable powers of observation, he should have
allowed himself, in opposition to the very principles which
he advocated so strongly, to indulge in the making of
systems and hypotheses. He commenced by advocating
with enthusiasm the method of Hippocrates, and ended by
following the brilliant but not very trustworthy example
of Galen." (Dezeimeris.)

HERMANN BOERHAAVE OF HOLLAND 441

The number of treatises which Boerhaave published is
quite large, the 'most important among them being the
following: ^'Oratio de commendando studio Hippocratico,^^
1701; ^^Institutiones medicae in usus annuae exercitationis
domesticos,^^ 1708; ^'Aphorismi de cognoscendis et curandis
morhis in usum doctrinae medicae,'^ 1709 (English version
printed in London in 1742) ; and ^'Elementa chemiae,^^ 1732
(English translation by Peter Shaw, London, 1741).

Of the ''Aphorisms," one of the most widely known of
Boerhaave 's published treatises, I shall take the liberty of
saying a few words. This work is in reality a very concise
statement of the author's views regarding pathology,
pathological anatomy and therapeutics, and I believe that
the following paragraphs, although few in number, will
suffice to give our readers a fair idea of the general
character of the book. At the same time I must confess
that I have not found it an easy matter to understand and
satisfactorily digest many of the individual aphorisms, the
text of which has been compressed into such a small space.
It therefore does seem surprising to learn from one critic
that, if one wishes to ascertain what Boerhaave 's views are
with regard to the science of medicine, one should read
by preference the Commentaries of Van Swieten, who was
Boerhaave 's favorite pupil and assistant.

The following four or five aphorisms are typical speci-
mens belonging to the earlier sections of the book:—*

(7.) A disease when present in a body, must needs be the bodily
effect of a particular cause directed to that body.

(8.) Which effect being entirely removed, health is recovered,

(9.) It may be removed by correcting the illness itself in par-
ticular, viz., by the applications of medicines to the particular
diseased part, or by some remedies which operate equally upon the
whole : the first we '11 call a particular, the latter a general cure.

(10.) The way to both is discovered either by observation, or
by comparing one case with another, or by a true reasoning from
them both.

(13.) He who doth, with the greatest exactness imaginable,
weigh every individual thing that shall happen or hath happened

2 Quoted from the English translation mentioned above.

442 GROWTH OF MEDICINE

to his patient and may be known from the observations of his own
or of others, and who afterward compareth all these with one
another, and puts them in an opposite view to such things as happen
in an healthy state; and lastly, from all this, with the nicest and
severest bridle upon his reasoning faculty, riseth to the knowledge
of the very first cause of the disease, and of the remedies fit to
remove them; he, and only he, deserveth the name of a true,
physician.

Then Boerhaave proceeds to make a classification of
diseases, and among the very first groups which one finds
in this classified list are the following: ''Distempers of
a lax and weak fibre " ; ' ' Distempers of the stiff and elastic
fibre"; ''Distempers of the less and larger vessels";
"Distempers of weak and lax entrails"; "Distempers of
the too strong and stiff entrails"; etc. — from which it is
apparent that the old doctrine of the strictum and the
laxum, which was taught by the Methodists in the early
centuries of our era, has here been adopted by Boerhaave
in all its essential characters ; and also that the treatment
which he recommends for some of these classes of maladies
does not materially differ from that advocated by this
ancient school of medicine. The following extracts, I
believe, will suffice to give the reader a fairly clear under-
standing of what Boerhaave means by the expressions
"distempers of the solid simple fibre," "distempers of a
lax and weak fibre, ' ' and ' ' distempers of the stiff and elastic
fibre," and will at the same time show what methods he
employed for overcoming these distempers. At the time
when Boerhaave made use of the term "fibre" (fibra) in
the very uncertain sense in which he here employs it,
Leeuwenhoek and Malpighi were demonstrating, by aid of
the newly perfected microscope, that the so-called simple
tissues were in reality quite complex structures; and one's
first impulse, therefore, is to express surprise that a physi-
cian of such high standing as our author should have used
the term. But we moderns must not forget that, in those
early days, it took decades for knowledge of this nature to
spread even a very short distance, as from Delft to Leyden,
and then to exert its legitimate influence upon^ medical

HERMANN BOERHAAVE OF HOLLAND 443

thought — that is, to be digested and afterward permanently-
appropriated. There can be scarcely any doubt that, at the
time (1709) when Boerhaave wrote these aphorisms, he had
already heard about the existence and the capabilities of
the recently perfected microscope, but it is not at all likely
that he had as yet digested the gains in anatomical knowl-
edge which had been acquired through the assistance of this
instrument. The extracts referred to above are the
following : —

DISTEMPERS OF THE SOLID SIMPLE FIBRE

(21) Those parts (which, being separated from the fluid con-
tained in the vessels, are applied and sticking to each other by the
strength of the living body, and make the least fibre) are the least,
the simplest, earthy, and hardly changeable from or by virtue of
any cause, which are found in our living bodies.

DISTEMPERS OF A LAX AND WEAK FIBRE

(24) The weakness of the fibre is that cohesion of the minutest
parts described (21), which is so loosely linked that it may be
pulled asunder even by that degree of motion which is requisite
in healthy bodies, or not much exceeding it,

(26) The weakness produceth easily a stretching and a breaking
of the small vessels made up of those weak fibres (24), and conse-
quently abates of their power over the fluids therein contained;
from which distensions arise tumors, from the stagnating or
extravasated liquids putrefactions, and, farther, all such innumer-
able ills as are the consequences of them both.

(28) [In distempers of a lax and weak fibre] the cure must be
obtained, 1. By aliments that abound in such matter as is described
in section 21, and which [should] be almost so prepared beforehand
as they are in a strong and healthy body; such are milk, eggs,
flesh-broths, panadoes^ rightly prepared of well-fermented bread;
and rough wines. All which must be given in small quantities, but
often, 2. By increasing and invigorating the motion of the solids
and fluids by means of frictions with a flesh-brush, or with flannel ;
by riding on horse-back, and in a coach, or by being carried in a
boat; and lastly by walking, running and other bodily exercises.
3, By a gentle pressure or a bandage upon the vessels, and a
moderate repelling of the liquids therein contained. 4. By medi-

3 Bread boiled in water to the consistence of pulp.

444 GROWTH OF MEDICINE

cines both acid and austere, or such as are spirituous and well
fermented, but applied with great caution and gentleness. 5. By
any means that will remove and remedy the too great pulling of
them.

[That Boerhaave belonged to the iatrophysical or iatro-
mechanical school appears very clearly throughout these
quotations.]

DISTEMPEES OF THE STIFF AND ELASTIC FIBEE

(35) [In distempers of this group] the cure is effected, 1. By
such meat and drink as is thin and watery, without any roughness,
chiefly by the continued use of milk-whey, of the softest herbs and
salads, barley-water, thin gruel, and unfermented liquors. 2. By
avoiding of exercise, and dwelling in a moist, coolish air, and taking
long sleeps. 3. By the taking or outwardly applying watery, luke-
warm, tasteless medicines, and such as contain the lightest and
softest oils.

In the second half of the volume I find abundant evidence
of Boerhaave 's ability to treat efiiciently some of the acute
and chronic maladies; and, after a perusal of the text
which deals with these affections, I have no difficulty in
understanding how he came to be looked upon as one of
the leading medical practitioners of the period during which
he lived. I should be glad to reproduce here such portions
of the aphorisms as would corroborate the statement that
I have just made, but unfortunately the small amount of
space that I can command does not permit me to do this.
At every step, as I advance, I am warned against the danger
of exceeding the limits permitted, and I shall, therefore,
in the present instance, have to rest satisfied with quoting
the larger part of a single paragraph in which is given an
account of the treatment employed in a case of acute
pleurisy.

(890) If the same pleurisy be recent before the end of

the third day, yet violent from the many and strong symptoms,
and dry, in a strong, exercised, dry body, without the hopes of the
presence of (887 and 888) [a resolution or a concoction and excre-
tion of the cause], then let the patient immediately be blooded

HERMANN BOERHAAVE OF HOLLAND 445

largely, with a qui^k running stream out of a great vessel, and a
large orifice, keeping his body quiet and leaning backwards, enforc-
ing his breathing all the while with coughing or panting, fomenting
the side at the same time, and gently rubbing it; which bleeding
ought to be continued till the pain seems to abate pretty consider-
ably, unless a fainting fit forces you to leave off sooner ; at whose
approach the vein must immediately be stopped. Bleeding ought
to be repeated according as these symptoms do return upon whose
account it was done the first time; and when that skin doth not
any longer appear upon the surface of the blood, it is time to
forbear more bleeding.

From the beginning ought to be used fomentations, bathings,
warm streams, liniments, plaisters, and the like; which may be of
use as they loosen, resolve, mitigate, and avert

As only extracts of considerable length would suffice to
give our readers a satisfactory idea of the attractive manner
in which Boerhaave deals with the subject of chemistry, I
prefer to omit them altogether, and to recommend to those
who are specially interested in this branch of science, that
they consult Peter Shaw's excellent English translation of
the ^^Elementa Chemiae.^'

Albert von Haller, the celebrated Swiss physiologist and
historian of medical literature, speaks of Boerhaave as
*'my beloved preceptor, a man of refined taste and a
speaker or lecturer so logical and charming that one more
gifted can hardly be imagined."

CHAPTER XXXV

GENERAL REMARKS ON THE DEVELOPMENT OF
SURGERY IN EUROPE DURING THE FIFTEENTH
AND SIXTEENTH CENTURIES

In the early period of the Renaissance surgery was
apparently the first of the practical branches of medicine
to spring forward into active life. Anatomy, — that is,
human anatomy, — the foundation that is absolutely neces-
sary to the solid growth of surgery, scarcely existed before
the beginning of the sixteenth century; and it is therefore
not surprising that the records of the past reveal to us so
very few instances of men who attained any eminence as
surgeons. When this fact is taken into consideration I
cannot help feeling that, in the sketches which I drew,
on earlier pages, of Theodoric of Cervia, William of
Saliceto, Lanfranchi of Milan (and later of France), Henri
de Mondeville and Guy de Chauliac, I gave to these men
only a small fraction of the credit to which they were justly
entitled. Indeed, the excellence of the work done by them
and recorded in the treatises which they published, is so
great as to arouse the suspicion that they had clandestinely
acquired more knowledge of human anatomy than they
dared to admit. The life of a dissector of human bodies, it
should be remembered, was by no means safe in those days.

But the lack of a trustworthy knowledge of anatomy was
not the only hindrance to a healthy development of the art
of surgery. There were other obstacles which, up to a
comparatively late period in the sixteenth century, con-
tinued to block the advance of this art. Of these, the
principal one was perhaps the custom — not by any means
considered at that period professionally dishonorable — of

GENERAL REMARKS ON SURGERY 447

keeping secret ^he technique of certain operative pro-
cedures like that of cutting for stone in the bladder or that
of the radical cure of hernia. Such knowledge was treated
as private property, and was very carefully handed down
from father to son, or was sold for a large sum of money
to certain surgeons who engaged, under oath, not to reveal
the details to others. Thus we are assured by Haeser that
two such eminent surgeons as Ambroise Pare and Fabricius
of Hilden were obliged to pay handsomely for the infor-
mation which they received from certain specialists con-
cerning their particular methods of procedure. It is from
such scraps of information which come to our knowledge
casually that we often learn the actual truth concerning
the advance made at a given period of time by a certain
department of medical science. Although it is not possible
to fix the date when the custom to which I have just referred
was definitely abandoned, it may be stated as a fact that
after the seventeenth century very few instances of such
ownership of surgical secrets are discoverable in the
records.

Inasmuch as at the very beginning of the Renaissance
surgery was looked upon, in the southern and central parts
of Europe, as an occupation of a somewhat menial char-
acter, the regularly organized medical schools made very
inadequate provision for the proper education and training
of those young men who were disposed to adopt a surgical
career. During the fourteenth and fifteenth centuries
surgery was still tolerated at Montpellier, but after the
papal seat had been removed from Avignon to Rome —
that is, after 1479, — the pupils of that university were
forbidden to do any surgical work. In 1490, however, a
course in surgery was provided for the exclusive use of
barbers. At first the instruction was given in Latin, but,
as these men did not understand this language, the pro-
fessor was soon compelled to employ a barbaric Latin
(half French and half Latin) in making his comments upon
the text of the lecture. This state of affairs lasted for more
than a century. In fact, it was not until after Pare, Franco
and Wuertz had demonstrated by their remarkable careers

/

448 GROWTH OF MEDICINE

how honorable was this branch of the science of medicine,
that provision was made at Montpellier (in 1597) for
regular instruction in surgery. But even then, for a period
of several years, it was found to be a very difficult matter
to keep the peace between the two groups of students — the
medical and the surgical; the governing authorities being
finally obliged, in order to prevent the encounters which
frequently took place between the rival bodies, to appoint
four a.m. as the hour when the instruction in surgery was
to be given. Those students who were pursuing the course
.in medicine looked upon the surgical pupils as intruders,
as men unworthy to associate with them, and they availed
themselves of every possible opportunity for making their
connection with the university unpleasant.

In Paris, during the twelfth and thirteenth centuries the
surgeons formed themselves into corporations. Minor
surgery was left entirely in the hands of the barbers (a
word which is derived from the Latin ^^barbarus,'^ uncul-
tivated) and barber-surgeons. They were largely itinerant
practitioners and army surgeons. As they traveled from
one city to another, the more enterprising ones announced
their approach by means of a sort of herald who proclaimed
loudly the cures which his chief was able to accomplish.
In the course of time the surgeons who lived in Paris
formed themselves into the so-called '* College of Surgeons."
At a later date (1255) there was established in that city by
Jehan Pitard, the surgeon of Louis the Ninth ('^ Saint
Louis," 1215-1270), a more perfect organization under the
name of the '* College of Saint Cosmas," which was placed
under the protection of Saints Cosnias and Damian. The
members of this Brotherhood were known as *' Surgeons
of the Long Robe," to distinguish them from the Barber-
Surgeons or ' ' Surgeons of the Short Robe ' ' ; and they were
also known as ^^Maitres Chirurgiens Jures.^' Through the
influence of Pitard this organization received from the King
a set of governing rules or constitution.

It may prove interesting to learn who Cosmas and
Damian were, how they came to be canonized, and for what
reasons the organizers of the new brotherhood preferred

GENERAL REMARKS ON SURGERY 449

them to all others, as guardian saints. Cosmas and Damian
were the youngest of five brothers who belonged to a family
of some distinction in Arabia. They chose the career of
peripatetic physicians, and gave their services free to those
who might have need of them. They spent some time in
the Province of Cilicia, Asia Minor, and while in that
country they met the death of martyrs, somewhere about
287 A. D,, during the persecutions of the Christians which
occurred in the reign of Diocletian. In the church pictures
they are represented as physicians, each one of whom holds
in his hand either a vessel containing a remedial prepara-
tion, or a staff around which the emblematic serpent is
twined, or (less frequently) a surgical instrument of some
kind. During the time of the Crusades there existed an
Order of Knights of Saint Cosmas and Saint Damian, who
devoted themselves specially to the care of sick pilgrims
and to the freeing of those who were held as prisoners.

In all the large cities of France there existed, during the
fourteenth and fifteenth centuries, corporations of surgeons,
the great majority of whom belonged to the class or grade
of barbers. These men were not permitted by their rules
to use the knife, and, as a result, great jealousy existed
between them and the few who, having passed the required
examination, were authorized to perform cutting operations
and to assume the title of ' ' Masters in Surgery. ' ' In 1493,
as the result of an effort made by the barbers of Paris as
a body, to gain some knowledge of medical science, they
obtained from the university permission to purchase a
corpse which had not yet been removed from the gallows.
They had, it appears, engaged a doctor of medicine to give
them instruction in anatomy, and it was upon a dissection
of this body that the teaching was to be based. In 1494 the
Faculty made provision for giving the barbers a regular
course of lectures on surgery; and, eleven years later
(1505), additional privileges having in the meantime been
granted them by the university, they organized the ''Cor-
poration of Barber Surgeons, or Surgeons of the Short
Robe. ' ' In the oath which the members of this organization
were obliged to take, it is expressly stated, among other

450 GROWTH OF MEDICINE

things, that * ' they will give due honor and reverence to the
Faculty, and will not administer any laxative or alterative
drug. ' '

From 1601 to 1731, when the Academie de Chirurgie was
founded, there was an almost continuous series of squabbles
between the surgeons and the barbers, on the one hand,
and the Medical Faculty of the University, on the other.
At a still earlier period, dating back even to the fourteenth
century, the quarrels were between the surgeons (Ecole
de St. Come) and the barbers, but, during the seventeenth
century and the early part of the eighteenth, the surgeons
and the barbers seem to have harmonized their interests
and to have made common cause against the Faculty. An
edict was issued by Louis the Twelfth in 1613 to the effect
that the two corporations (the surgeons and the barbers)
should be fused into a single organization; and, even
before this, it had become customary to employ the words
''surgeon" and ''barber" as synonymous terms. Finally,
in the years 1644, 1645 and 1656, further agreements were
entered into by the two bodies. After the founding of the
Academy of Surgery in 1731 nothing further is heard of
barber-surgeons.

In the account which I have thus far given of the agencies
that were available during the Renaissance for the perpet-
uation and increase of medical knowledge, I make reference
only to the established medical schools and to the less
pretentious but much more practical teaching organizations
furnished by the guilds or brotherhoods. In my remarks
I have said little or nothing about hospitals, which —
potentially, at least, — have a great deal to do with the
advance of medical knowledge, especially in the department
of surgery. Unfortunately, my efforts to procure informa-
tion relating to this subject have not been rewarded with
much success and I shall therefore not be able to furnish
more than a few disconnected and very imperfect details.

At the beginning of the sixteenth century the city of
Lyons possessed (and it still possesses) the oldest hospital
in France — viz., the Hotel-Dieu, — which was founded by
Childebert the First in 542 A. D. The city itself was at

GENERAL REMARKS ON SURGERY 451

that period second, in importance only to Paris, and in some
respects it was the equal of the metropolis in celebrity.
The art of printing was introduced there in 1472, and the
presses of that city were soon reckoned the best in Europe.
Many medical books were published at Lyons. Francois
Rabelais (1483-1553), the celebrated author of the humorous
and satirical works ''Gargantua" and ' * Pantagruel, " was
a regularly educated physician, and during his residence
at Lyons he edited various works of Hippocrates and Galen.
Michael Servetus, who displayed such marked ability by
his researches in regard to the circulation of the blood, was
also a resident of Lyons from 1530 to 1543. Some idea of
the way in which a large hospital was managed in those
early days may be gained from the following statement of
facts : In 1619 as many as five patients were permitted to
occupy one bed in Hotel-Dieu at Lyons. Although the
hospital possessed accommodations for a total of five
hundred and forty-nine patients (including pilgrims and
poor people), there was only one medical man whose duty
it was to look after the surgical cases, and he resided out-
side the building. At a somewhat later date there was
provided a ^^chirurgien principal,^ ^ whose duty it was to
give the needed surgical care to this class of patients, and
who was obliged to reside in the hospital. When this chief
surgeon required assistance in the dressing of wounds, etc.,
he was authorized to make use of the ** apothecary's boy."
The stock of surgical instruments possessed by the hospital
in 1543 comprised the following items: One uterine
speculum; one trephine, which was composed of thirteen
separate parts ; one mouth-plug, for use in keeping the jaws
separated; one ear speculum; and one elevatorium. All
these facts, taken together, furnish strongly corroborative
evidence of the statement made by von Gurlt in his
Geschichte der Chirurgie, viz., that in France, during the
sixteenth century, the occupation of surgeon was consid-
ered by the community but little better than that of a
hair-cutter. It is therefore not surprising that the great
hospital of Lyons should have been managed at that time
in accordance with such a low sanitary standard and with

452 GROWTH OF MEDICINE

an almost total disregard of the purposes for which a
hospital exists. So far as I am able to learn, the condi-
tions just described were not peculiar to the city of Lyons.
*' During the reign of Francis the First (1515-1547) there
were in the main room (thirty-six feet wide) of the
Infirmary of Hotel-Dieu at Paris," says Boisseau, ''six
rows of beds (three feet wide), each one of which accom-
modated ordinarily three (at times even four) sick persons,
who necessarily were very uncomfortable. This is not all ;
for there were also in this same infirmary seven or eight
beds which were designed to accommodate from twenty-five
to thirty infants or young children, the great majority of
whom died from the poor quality of air which they had to
breathe in that institution." I do not need to furnish
additional proofs in corroboration of the truth of the state-
ment that during the Renaissance the French civil hospitals
contributed practically nothing to the advance of medical
science. It is possible that in Italy these institutions may
have been better managed, for, in the account which he gives
of his trip to Rome, Luther speaks of having visited a
hospital which particularly attracted his notice by reason
of its orderliness and the conspicuous cleanliness of every
part of the building. As an offset, however, to this favor-
able testimony I should state that in some documents
discovered in comparatively recent times there are memo-
randa relating to the duties of the medical staff in the civil
hospital of Padua (1569) — a city in which was located the
most famous medical school to be found anywhere in
Europe during the sixteenth century. These memoranda
read as follows : ' ' There shall be a doctor of physic upon
whom rests the duty of visiting all the poor patients in
the building, females as well as males ; a doctor of surgery
whose duty it is to apply ointments to all the poor people
in the hospital who have wounds of any kind ; and a barber
who is competent to do, for the women as well as for the
men, all the other things that a good surgeon usually does. ' '
(The word ''surgeon" is evidently employed here in the
sense of barber-surgeon, and not in the modern sense of
the word.) This testimony and that furnished on a pre-

GENERAL REMARKS ON SURGERY 453

ceding page withi regard to the management at the two
leading civil hospitals in France amply justify the state-
ment that during the sixteenth century medicine received
no aid whatever from these institutions in its efforts to
advance.

For the sake of orderliness I shall, from this point
onward, arrange the information which I may find it
desirable to furnish, under the headings of the different
countries of Europe ; and in carrying out this plan I shall
begin with Germany, as it was there that the oldest fifteenth-
century treatises on practical surgery were first printed.

CHAPTER XXXVI

SURGERY IN GERMANY AND SWITZERLAND
DURING THE FIFTEENTH AND SIXTEENTH
CENTURIES

There were five men in Germany and German Switzerland
who, during the Renaissance, attained distinction as sur-
geons, and who at the same time contributed, by their
published writings as well as by the force of example, to
the advancement of medical science. The names of these
five surgeons are : Pfolspeundt, Brunschwig, von Gerssdorff,
Fabricius of Hilden and Felix Wuertz. The first three
mentioned were born in the early part of the fifteenth
century, and all five of them derived their practical knowl-
edge of surgery in large measure from their experience
in warfare. Individual sketches of these men will be
furnished farther on, but I believe that these will be better
understood if a brief account of the state of medical
education in general throughout Germany, at the period
which I am now considering, be first supplied.

State of Medical Education in General Throughout Ger-
many (1400-1600). — The University of Heidelberg was
founded in 1386, but it was not until about 1550 that the
first beginnings of medical teaching made their appearance
in that institution. Equally feeble attempts were made,
twenty years later, to organize the teaching of medicine at
the University of Wuertzburg; but very little appears to
have been accomplished during the immediately following
years, as may,, be judged from the official announcement,
in 1587, of what things the Professor of Surgery would
teach in the three-years' course. ^^ First year: Lectures
on the subject of tumors, in accordance with the teachings

EARLY SURGERY IN GERMANY 455

of Galen; Secon^ year: Lectures on the subjects of wounds
and ulcers, in accordance with the teachings of Galen and
Hippocrates and the Arabian medical writers; Third year:
Lectures on fractures and dislocations, in accordance with
the teachings of Galen and Hippocrates. Then, if sufficient
time is available during this last year of the course, a
certain amount of anatomy is to be taught (during the
winter season) from Galen's writings on this subject. In
the summer time the subject of simple remedies may be
taken up advantageously, and botanical demonstrations
may also be given." Von Gurlt quotes Koelliker as his
authority for the statement that throughout the seventeenth
century the medical and surgical teaching at the University
of Wuertzburg was very defective, * ' almost nothing worthy
of mention being accomplished during that long period in
the departments of anatomy and physiology." In the
University of Basel, Switzerland, which was founded in
1460, medical teaching was as barren as it was in all the
German universities at that early period. It was only in
1542 that the first public dissection of a human body took
place there. Vesalius was visiting the city at that time for
the purpose of superintending the printing of his great
work on anatomy, and the university authorities availed
themselves of the opportunity to secure from him not only
this single demonstration, but also in addition a course of
lectures on anatomy. Fifteen years later, Felix Platter,
a native of Basel and a man of exceptional ability (see
sketch on pp. 332 et seq.), made the first postmortem
examination known to have been made in that city. Two
years later still (1559), following in the footsteps of
Vesalius, he made a public dissection of a criminal's corpse
in the Church of St. Elizabeth. From 1581 onward, with
occasional omissions, a public dissection of the corpse of
a criminal was made by the professor of anatomy once
every year. In 1590 the question was discussed by the
Faculty whether it ** might not also be practicable to secure
from the hospital, for dissection, an occasional corpse."
The first body obtained from this" source was dissected in
1604, but it was not until 1669 that a second one was avail-

456 GROWTH OF MEDICINE

able. There was no museum of anatomy and the medical
school owned only two human skeletons — one male, that
had been set up by Ves alius, and one female which had
been prepared by Platter. During the first two hundred
years of the existence of this university, only twenty-three
copies of the different writings of Hippocrates, of Galen,
of Dioscorides and of Paulus Aegineta were available for
the instruction of the medical students. ''These books
should be diligently read aloud to the young men if their
contents are to furnish the maximum of useful informa-
tion." As for clinical instruction, each student was
expected to secure for himself, by private arrangement
with some active practitioner, the position of assistant, or
to obtain from the Archiater or City Physician an occa-
sional opportunity of seeing patients at the hospital.
According to the rules established by the Faculty the
students were permitted to take private courses with
different physicians. Another and very valuable source
of information that was within the reach of these young
men, was supplied by the public disputations which were
held quite frequently.

The preceding brief account, which I have compiled from
von Gurlt's work, will serve, as I believe, to convey a fairly
clear idea of the primitive and very limited opportunities
of acquiring a knowledge of medicine and surgery which
were afforded the student in Germany during the fifteenth
and sixteenth centuries. (It should be borne in mind that
Basel, although located in Switzerland, was in nearly all
respects a German city.) It was not until a much later
period that the schools of that country, in nearly every
department of human knowledge, caught up with and
eventually surpassed — at least for a number of years — the
similar institutions in Italy and France.

Hieronymus Brunschwig. — Hieronymus Brunschwig was
born at Strassburg during the early part of the fifteenth
century, the exact date not being known. It is believed
that he attained a great age, some even claiming that he
was one hundred and ten years old at the time of his death.
His treatise on surgery, bearing the simple title "Das buck

EARLY SURGERY IN GERMANY

457

der Wund Artzeny/' was first published in 1497, when he
was already an old man, and it passed through nine editions
during the following forty-two years. It was also twice
translated into English. Up to the time of the discovery

FIG. 18. CONSULTATION BY THREE PHYSICIANS UPON A CASE OF
WOUND IN THE CHEST.

(From a woodcut in the Surgery of Hieronymus Brunschwig, Strassbixrg. 1508.)

This treatise, which was written by the author in 1497, passed through nine successive
editions, the last one in 1539. Probably no woodcuts of a higher order of merit than those
represented in this and the two following illustrations (Figs. XIX and XX) are to be found in
medical literature.

/

458 GROWTH OF MEDICINE

of Pfolspeundt^s work it was believed to be the oldest
German treatise on surgery known. It was very freely
illustrated with original woodcuts, not a few of which
possess considerable artistic merit. (See accompanying
reproduction.) The following headings of some of the
more important chapters will convey at least a fair idea
of the character of the book: ** Definition of the Word
'Surgeon' "; ''Anatomy"; "Fatality of Wounds in Differ-
ent Parts of the Body"; "Different Kinds of Wounds";
"Different Kinds of Surgical Instruments"; "Different
Modes of Ligating Blood-Vessels"; "Wounds of Blood-
vessels and Nerves"; "Methods of Arresting Bleeding";
"Foreign Bodies in Wounds"; "Treatment of Wounds
Inflicted by Poisoned Arrows"; "Bruised or Crushed
Wounds"; "Stab Wounds"; "Bites and Stings";
"Wounds of the Head"; "Operations for Hare-Lip"; and
several other chapters on wounds and pathological condi-
tions of other parts of the body. Syphilis is not once men-
tioned in the book; and from this circumstance von Gurlt
infers that a knowledge of the existence of this disease
had not yet, at that early date (1497), reached Germany.
In Brunschwig's Liber pestilentialis, etc., however, which
was printed three years later, syphilis is incidentally
mentioned as the ^'malefrancose^^ or '^ malum mortuum.'*
That Brunschwig was well informed in the earlier surgical
literature is shown by the fact that he quotes from the
writings of Theodoric, Guillaume de Saliceto, Guy de
Chauliac, Henri de Mondeville, and many others. A hasty
and necessarily very superficial perusal of the text of a
few of the more important chapters of this remarkable
book satisfies me that Brunschwig deserves to be classed
among the really great surgeons of the fifteenth and six-
teenth centuries. A copy of this rare book may be seen
in the Surgeon-General's Library at Washington, D. C.

Heinrich von Pfolspeundt. — The earliest German treatise
relating to surgery is that which bears the title ^^Buch der
Bundth-Ertznei,^' by Heinrich von Pfolspeundt, '^Bruder
des deutschen Or dens.'' ^ It was written in 1460, and was
first published in printed form in 1868 by H. Haeser and

EARLY SURGERY IN GERMANY 459

A. Middeldorpf, Berlin. The text of this very early
German work on the practice of surgery furnishes ample
evidence to show that the author was worthy to be ranked
among the leading surgeons of the fifteenth century. At
page fifty-seven, says von Gurlt, may be read the remark-
able statement that, in the case of a wound of the intestinal
canal, ane may cut through that organ at the point of injury
and then introduce into the opposite ends of the divided
bowel a silver tube the margins of which have been care-
fully bent so as not to oifer at any point a cutting edge.
The tube may then be tied in place with thread of green
silk. (Von Gurlt speaks of this as the forerunner of
Murphy's button.) Speaking of wounds caused by arrows,
Pfolspeundt says that, to insure the patient's recovery, the
planet under which he happens at that time to be, should
be in favorable conjunction. In one case which came under
Pfolspeundt 's care he was obliged to pay an astrologer
the sum of fifty gulden in order to ascertain whether the
planet in question was or was not in a favorable conjunction.

There is only one place in the entire book, says von
Gurlt, where a gunshot wound is mentioned, and then only
incidentally; but this is positively the first reference (about
the middle of the fifteenth century) to such wounds dis-
coverable in medical literature.

Among the topics which are treated quite fully and in
such a manner as to show clearly that the author was well
versed in at least this part of operative surgery, those
relating to rhinoplasty deserve to receive special mention.
From the viewpoint of history, this part of the book is of
very great importance. In no other treatise, says von
Gurlt, do we find an equally detailed and satisfactory
account of the operative method employed by the Two
Brancas (father and son, from Catania, Italy), who were
contemporaries of Pfolspeundt. The latter learned this
method from an Italian surgeon, whose name he does not
mention, and he was particularly careful not to divulge
the essential details to anybody except two of his brethren
in the Order to which he belonged.

For anaesthetic purposes in operative cases, Pfolspeundt

/

460 GROWTH OF MEDICINE

was in the habit of employing sponges saturated with the
juices of opium, Atropa mandragora, Conium maculatum,
Hedera helix or arborosa, Lactuca and Daphne mezereum ;
his technique resembling very closely that employed by
Guy de Chauliac, Theodoric and others. (See the appro-
priate chapters in the earlier part of this volume.)

In his remarks upon the manner of bringing about the
healing of an open wound, Pfolspeundt says that ''in all
cases he tries to dispense with stitches, but that, when he
finds such support necessary, he first spreads a thick layer
of adhesive material over both margins of the wound and
afterward introduces the threaded needle through the mass
into the skin. Then, in order to bring the edges of the
wound together, he draws the thread taut and makes it

fast by means of a very small knot Whether the

sharp fever which sometimes sets in afterward as a com-
plication, is due to simple inflammation or to erysipelas,
is a question which cannot always be decided; and it is
still more difficult to determine whether the thin watery
secretion which sometimes develops in a wound may
not signify — as some writers maintain — the beginning of
suppuration in a joint."

Were it not for the difficulty which one experiences in
translating correctly the ancient provincial German of
Pfolspeundt 's text, I might readily furnish further
examples of his surgical pathology and methods of treat-
ment. The few, however, which I have already given will
have to suffice.

Hans von Gerssdorff. — Hans von Gerssdorff, who was
also called "Schielhans" (squint-eyed Hans), was born in
Strassburg about the middle of the fifteenth century. He
was a bold and skilful surgeon, and acquired a wide expe-
rience and great self-confidence from his long service in
connection with the army. He was present, for example,
at the famous battles of Grandson (1476, in Switzerland)
and Nancy (1477, in France), in both of which the slaughter
was very great, and in both also Charles the Bold, Duke
of Burgundy, was badly beaten. In 1517 von Gerssdorff
published at Strassburg a treatise on military surgery,

FIG. 19. BARBER-SURGEON {IVUNDARZT) EXTRACTING AN ARROW FROM

A WOUNDED SOLDIER'S CHEST WHILE THE BATTLE

IS STILL IN PROGRESS.

(From the Feldbuch der Wundarzneioi Hans von Gerssdorff, first published in 1517; many-
later editions followed.)

462 GROWTH OF MEDICINE

under the title: ^'Feldhuch der Wundartzney.''^ This book,
which is illustrated with exceptionally good woodcuts, two
specimens of which are here reproduced (Figs. 19 and 20),
contains the earliest discussion of gunshot wounds ; and, in
his remarks on the proper manner of treating such wounds,
von Gerssdorff leads one to infer that he shared, although
somewhat hesitatingly, the at that time prevailing belief
that these wounds are poisoned. He was a pronounced
advocate of the use of the red-hot cautery in cases of serious
hemorrhage from a wound. When it was found that the
ball had penetrated the flesh to some depth, he recommended
that it be cut out ; and if, after the removal of the missile,
the patient complained of much pain in the wound, hot oil
was to be poured into it freely. Before the employment
of firearms in warfare, amputation of a limb was rarely
performed — that is, only in cases where gangrene had
developed in the corresponding hand or foot. But von
Gerssdorff assures us that, up to the time of writing his
'^Feldbuch,'^ he had personally performed *' nearly two
hundred amputations." This great increase in the fre-
quency of performing this operation is clearly to be
attributed to the increased use of the new agent — gun-
powder— in warfare. In this operation, according to his
own declaration, von Gerssdorff was not in the habit of
suturing the flaps. Instead, he brought the opposing edges
together and then covered the stump thus formed with the
bladder of some animal. There are a number of other
interesting details relating to von Gerssdorff 's manner of
conducting this important operation, but it is not practi-
cable to give up the space that would be required for a
satisfactory description of them. There is one point,
however, to which I may be permitted to refer very briefly
in this place, viz., the manner in which the surgeons of this
and even much earlier periods secured a fairly satisfactory
degree of local anaesthesia when they had occasion to
perform an amputation. They produced insensibility of
the part by tying a band tightly around the limb a short
distance above the spot at which the amputation was to
be performed. At a somewhat later period, as in the middle

PIG. 20. AMPUTATION OP THE LEG.

(From Hans von Gerssdorff 's Feldbuch der IVundarznei.)

,f almb"""'' "^' '''"' '^" " '""^ ^"'•"^^* '^'^°"° P''^^--^ '""^tratlon of the amputation

464 GROWTH OF MEDICINE

of the seventeenth century, artificial anaesthesia was also
effected through the application of snow or ice to the part.

The date of von Gerssdorff 's death is not known.

Fabricius of Hilden. — Fabricius Hildanus — or Fabricius
of Hilden, near Diisseldorf — was born in 1560 and received
his early training in surgery from Cosmas Slotanus, a pupil
of Vesalius and the first barber-surgeon of Duke Wilhelm
of Guelich-Cleve-Berg (eighteen miles northeast of Aix-la-
Chapelle). In 1585 he visited Geneva, Switzerland, and
continued his studies in that city under the guidance of
Jean Griffon, one of the most distinguished surgeons of
that period. After leaving Geneva he practiced medicine
at Cologne, and during that period (1591-1596) steadily
increased his reputation as a skilful surgeon, particularly
well versed in anatomy. But he appears to have acquired
a strong liking for Switzerland and for the professional
friends whom he had gained in that country; and conse-
quently it is not surprising to learn that, during the later
years of his life, he spent long periods of time in Geneva,
Lausanne and Berne, in the last of which cities he filled
the office of City Physician. He died in 1634, at the age of
seventy-four, full of honors and greatly beloved by all who
knew him.

Fabricius of Hilden laid great stress upon the importance,
to the surgeon, of a thorough grounding in anatomy. He
had been profoundly impressed by the fact that his in-
structor at Geneva, Jean Griffon, never undertook an
important operation until after he had refreshed his
memory by a dissection of the region involved. He was
also much interested in pathological anatomy, and always
availed himself of every possible opportunity for making
a postmortem examination. As evidence of the slowness
with which news of important scientific discoveries, par-
ticularly in the domain of medicine, traveled in those days
I may mention here the fact that, up to the time of his
death in 1634, Fabricius had not heard of Harvey's great
discovery of the circulation of the blood (1628). Although
he gained distinction in more than one field of medicine his
greatest reputation was unquestionably gained in that of

EARLY SURGERY IN GERMANY 465

surgery; and his success in this field was to be ascribed
to his profound knowledge of anatomy, to his inventive
genius, and to his great technical skill. He insisted very
strongly upon the importance, for the surgeon, of pos-
sessing good instruments and well-constructed apparatus.

If we compare Fabricius of Hilden with Ambroise Pare
we are obliged to. admit that the latter, although decidedly
inferior to his rival in scientific training, was the greater
surgeon of the two. It is perhaps worth recording that
Paracelsus and Wuertz were Fabricius' bitter opponents.

Of his published contributions to surgical literature, the
most important are to be found in the work entitled:
^'Observationum et curationum chirurgicarum centuriae
VII. ,^^ published at Lyons in 1641.

Felix Wuertz. — Felix Wuertz was born at Zurich, Swit-
zerland, between the years 1500 and 1510 (the exact date is
not known). As to his early life and surroundings I am
only able to say that his father was a painter, that he him-
self took service under a barber, and that at the end of two
or three years, after he had learned the details of this
branch of work, he started out on his travels over Europe
in the character of a barber's apprentice, as was, in those
days, the regular custom with apprentices of all trades or
occupations. In this way he visited such cities as Bamberg,
Pforzheim, Nuernberg, Padua and Rome, in each of which
he spent a certain length of time as an aid to those surgeons
who were willing to employ him. It is not unlikely that it
was during this wandering period of his life that he gained
some experience in the treatment of gunshot wounds. In
1536, after an absence of four or five years, he returned
to his native city and was regularly enrolled as a member
of the barbers' guild. During the following twenty years
he carried on the practice of medicine and surgery, but
more particularly the latter, with ever-increasing success.
In 1559, for reasons which are not mentioned by any of
his biographers, he left Zurich and established himself in
Strassburg; and then, at the end of another ten or twelve
years, he again changed his residence, this time giving the
preference to Basel, a Swiss city located at the boundary

466 GROWTH OF MEDICINE

line between Germany and Switzerland. The exact date
of Wuertz's death is not known, but — from various facts
which he mentions in his book — it may be inferred that it
occurred in 1576, and that he was residing at the time in
the house of his son, who had the same name as himself
and was also a surgeon. The title of the treatise which he
wrote and which passed through a number of editions
between the years 1563 and 1651, — not to mention trans-
lations into the French and Dutch languages — was:
^^Practica der WundarzneV (The Treatment of Surgical
Affections).

Malgaigne — says von Gurlt, in his History of Surgery —
does not hesitate to speak of Wuertz as one of the three
greatest surgeons of the sixteenth century (Franco and
Ambroise Pare being the other two) ; and von Gurlt adds
that Wuertz's ^^ Practical ^ is rich in facts which he had
gathered from his own experience in everyday practice,
and upon which he makes comments that really represent
his own views and not those of various other authors. The
leading principles which guided Wuertz in his treatment
of wounds of all kinds are thus formulated by him : —

Keep them as neat and clean as possible, and disturb them as
little as you can; so far as may be practicable, exclude the air;
favor healing under a scab ; and do not give the patient a lowering
diet, but feed him as you would a woman recovering from her
confinement.

According to von Gurlt, Wuertz attached relatively small
importance to healing by first intention, and only in rare
cases did he make special efforts to secure this result. On
the other hand, he availed himself of every opportunity to
enter his protest against some of the bad tendencies which
had somewhat suddenly made their appearance in the
practice of surgery in his day, and more especially * * against
the almost universal employment of caustics and the red-
hot iron for arresting bleeding; against the uncalled-foi
and positively harmful habit of repeatedly probing a
wound; against the unreasonable practice of inserting
tents into wounds ; against the uncontrolled application oi

EARLY SURGERY IN GERMANY 467

mushy poultices to wounds; and against the excessive
employment of bloodletting in the treatment of wounds."
He exhibited his conservatism in still other ways. Thus,
for example, he was very slow in reaching a decision to
amputate a limb or to remove splinters or larger portions
of loose bone from a wound, for he put greater trust in the
reparative powers of Nature than did most of the surgeons
of that day. Wuertz was also slower than were most of
them in resorting to the operation of trephining the skull.
His ideas with regard to the nature of gunshot wounds
were not very clear, for he still believed that the projectile
caused some burning and a certain degree of poisoning of
the wound; but he condemned all unnecessary efforts at
extraction, especially by means of complicated instruments.
It was better, he said, to wait until the bullet or other missile
manfested its presence at some easily accessible spot in
the body.

The statements made above bring out some of the good
features of Wuertz 's treatise. This work, however, says
von Gurlt, also contains not a few bad features, and among
them he mentions the fact that it abounds in repetitions
and in evidences of the author's superstitiousness.

Some of Wuertz 's comments on the symptoms which
occasionally develop' in' cases of injury to the head, and
the suggestions which he makes *as to the treatment that
should be adopted, throw considerable light upon his mode
of procedure in the presence of certain surgical phenomena.
The following clinical lesson is based upon three hypo-
thetical developments in a case of cranial injuries : —

(1) The patient's wound in the head, let us suppose, has to all
appearances healed, when it unexpectedly becomes swollen and
painful and begins to discharge again. What measures are
indicated under these circumstances? The wound should at once
be freely reopened, for it may confidently be assumed that such a
lighting up of the local symptoms is due either to a loose splinter
of bone that is trying to escape or to the presence of a small area
of bone caries. If, under these circumstances, you should not
establish a free opening a large abscess will surely collect in that
region and will soon make for itself a new outlet.

468 GROWTH OF MEDICINE

(2) If the patient complains that he has constant pain in his
head on the same side as that on which the injury was originally
inflicted, that the pain is steadily increasing in severity, and that
in addition he feels a sensation of pulsation in his head; and if,
furthermore, you inspect closely the site of the original wound,
and pass your finger cautiously over the spot, but fail to discover
any appreciable external swelling, you may feel almost certain
that a splinter or a spicule of bone projects from the inner table
of the skull cap into the substance of the brain. Then, when the
surgeon believes that the condition as just described truly repre-
sents the existing intracranial lesions, he should not hesitate to
make an opening in the calvarium over the affected spot and remove
the offending splinter.

(3) If the patient, after the external wound has healed, com-
plains of a throbbing and roaring in his head, not merely in the
region of the actual injury but involving the entire head, and if
the symptoms tend rather to increase than to diminish, and
eventually become so severe that the patient is almost beside him-
self with the pain, then is the surgeon justified in believing that
a clot of blood is imprisoned somewhere beneath the cranium and
is gradually being converted into an abscess or a condition of
ulceration. And if at the same time some swelling appears in the
vicinity of the eyes, or if a bloody and purulent discharge begins
to flow from the nose or the ears, he may not merely entertain a
belief that his diagnosis is correct, but may assert with positiveness
that the lesions jiist named really exist. And then the proper
treatment for him to adopt is [in essentials] the following: The
head having first been shaved over the site of the original wound,
make a crucial incision through the scalp and pericranium, turn
the flaps back, apply a strong, sharp-edged chisel to the surface
of the bone, and remove enough of the cranium to afford a satis-
factory view of the underlying parts. [Among the effects first
observed] probably pus will well up into the opening, and the
patient will then experience relief; and if a spicule of bone comes
into view, remove it forthwith. The plan of treatment here sug-
gested is the only one which can be trusted to effect a cure in a

case like that which is now being considered If a boring

instrument is employed for making an opening in the bone, be
careful not to allow any of the chips made by the borer to enter
or remain in the cranial cavity. Some surgeons teach that, if pus
be not found at the first opening, a second one should be made at
the distance of a finger's breadth from the first, and that the inter-

EARLY SURGERY IN GERMANY 469

vening bone should be broken down with a strong and sharp knife
so as to convert the two into a single opening. [Wuertz adds that
he had never found it necessary to act in accordance with this
advice.] After the pus or clot of blood has been removed, one may
as a rule readily discover the true cause of the pain and other
symptoms. As a final step, suitable dressings should be applied
to the wound.

Another important department of practical surgery, in
which Wuertz appears to have gained special distinction, is
that which relates to wounds and certain diseases of the
abdomen. Owing to lack of space it will not be practicable
to reproduce here any histories of the cases of this nature
which came under his observation, but I believe that the
following brief extracts from his remarks upon the best
way of treating them may in some measure answer the
same purpose: —

Penetrating wounds of the abdomen are universally admitted to
be very dangerous, no matter what organs (stomach, intestines,
liver, gall-bladder, spleen or kidneys) be involved in the injury.
In the case of a wound of the liver or spleen it is not advisable to
employ sutures ; instead, one may use some kind of sticking plaster
for bringing the edges of the wound together. Proper regulation
of the diet plays an important part in the treatment of these con-
ditions, and so also may venesection. When an intestine is the
organ wounded I adopt the plan of treatment recommended by
most authorities; that is, I stitch together the opposite edges of
the wound and I cleanse the surface of the bowel carefully with
milk that has been well saturated with the juice of anise seeds.

In his remarks about the treatment of suppurative
processes involving the thigh in the vicinity of the knee,
Wuertz gives the following advice: —

Do not allow the knee to remain quiet, but stretch the surround-
ing parts and manipulate them as much as you can, in order that
the joint may not become permanently rigid; for if you wait until
the healing is completed before you resort to these measures you
will often find that it is already too late.

Separate chapters are devoted to such topics as would
to-day receive the designations *' pyaemia,'* ** hospital

/

470 GROWTH OF MEDICINE

gangrene," and '* septicaemia " ; and in a separate short
treatise which deals with the various ailments of young
children, Wuertz mentions the fact that he once suffered
greatly for ten days from an attack of migraine (hemi-
crania) and that he experienced marked and permanent
relief only after the operation of arteriotomy had been
performed upon his left temporal artery. In another part
of the volume he expresses himself in terms which justify
the belief that he must have performed amputation of the
thigh on one or more occasions. He does not, it is true,
furnish any details regarding the indications that point to
the necessity of resorting to this operation, nor does he
state how it should be carried out; he simply makes the
remark, while speaking of the employment of the red-hot
cautery iron in arresting hemorrhage, that * ' it is useful in
amputation of a limb, particularly in the thicker part of the
thigh, and occasionally in other places, as in the removal of
a tumor by the use of the knife." So far as I am aware,
Celsus was the first among ancient writers on surgery to
say anything about amputations, and what he does say on
this subject consists simply of quotations from still earlier
writers — from Archigenes, Leonides and Heliodorus, sur-
geons whose writings no longer exist except in the form
of detached extracts that appear in more modern treatises.
The portions of text which Celsus quotes show clearly that
the surgeons whom I have just named were in the habit
of making flap operations in cases of amputation above the
elbow and above the knee ; and Archigenes even taught the
advisability of first ligating the larger supply blood-vessels
before one proceeds to the amputation of a limb.

From the remarks which Wuertz makes in one or two
places it is easy to see that he was often not a little annoyed
by the criticisms which his professional brethren made with
regard to some of his methods of procedure. Thus, for
example, he boldly declares that one's experience is of
much greater value than any rule that may have been laid
down by the ancients.

There can be no doubt, he says, that the ancients occasionally
displayed great ignorance and great want of judgment, just as

EARLY SURGERY IN GERMANY 471

happens in our own time How much do you suppose I

care whether Galen's, or Avicenna's, or Guy de Chauliae's opinion
does or does not agree with mine ? Every such opinion — it should
be remembered — was, at one time or another in their day, a new

[and therefore unproved] opinion In practical surgery

much more importance attaches to the manner in which one carries
out one's manipulations, and to the amount of experience which
one may have acquired, than to the length of time which one
devotes to windy consultations.

Fortune conferred very few favors upon Wuertz in the
course of his career ; the aid granted by kings and princes
played no part in the moulding of his character ; his great-
ness was entirely due to his own unaided efforts. Pare,
on the other hand, was certainly one of Fortune 's favorites.
He, too, like Franco and Wuertz, began his professional life
as a barber's apprentice, but, as he was made of a much
finer clay, the ultimate product of his development was a
princely surgeon, perhaps no more efficient or skilful than
his two distinguished contemporaries, but unquestionably
more many-sided, more lovable than either of them. On
the other hand, Wuertz rendered a most valuable service
to the science of surgery by his close and patient study of
certain symptoms which his confreres had overlooked or
incorrectly interpreted (such, for example, as pyaemia,
hospital gangrene and septicaemia) ; and he thus estab-
lished the fact that these were in reality independent
diseases.

CHAPTER XXXVII

THE DEVELOPMENT OF SURGERY IN ITALY
DURING THE RENAISSANCE

During the latter part of the fifteenth, all of the sixteenth
and the early part of the seventeenth centuries quite a large
number of Italian surgeons attained honorable distinction
by the contributions which they made to the science of
medicine; and even in the neighboring Latin countries of
Spain and Portugal, — countries in which the force of the
revival of all departments of learning had made itself felt
to a much feebler degree, and in which at the same time the
opposition to such revival was much more active, — several
surgeons succeeded in winning creditable places for them-
selves in the history of their art. The names of the Italian
surgeons are as follows : Giovanni da Vigo, Bartolommeo
Maggi, Marianus Sanctus, Fallopius, Carcano Leone, Fab-
ricius ab Acquapendente, Aranzi and Tagliacozzi. I will
now add brief notices of the careers of all these men, in
order to convey at least some idea of the grounds upon
which their claim to honorable distinction rests.

Giovanni da Vigo — perhaps more frequently referred to
in literature by the French form of his name, *'Jean de
Vigo" — ^was born at Rapallo, near Genoa, Italy, about the
year 1460. He was the son of Bernardo di Rapallo, who
was also a surgeon; and he himself was the founder of a
school which sent out quite a number of practical surgeons.
In 1485 he began the practice of his profession at Saluzzo,
a small town about forty miles south of Turin; and ten
years later he settled at Savona, which is located on the
Mediterranean, a short distance to the west of Genoa. In
1503 he was chosen the personal physician of Cardinal

DEVELOPMENT OF SURGERY IN ITALY 473

Giuliano della Rovere, who resided at Savona, and he
continued to hold this position after the cardinal was
elected to the papal office under the name of Julius the
Second.

Da Vigo's great treatise on surgery {^^Practica in arte
chirurgica copiosa continens novem libros/' Rome, 1514)
owed its celebrity, during the early part of the sixte^jcith
century, chiefly to the fact that he was the first auth^OT to
write somewhat thoroughly upon syphilis and upon gunshot
wounds — two surgical disorders of great importance at
that time. As to gunshot wounds, da Vigo was one of the
first to maintain that they were poisoned wounds ; and for
a long time afterward this was the generally accepted
opinion. Like all his contemporaries, da Vigo was not
willing to undertake such operations as those for the cure
of stone in the bladder, for the relief of cataract, and for
the cure of hernia. He left these, says Haeser, to the
itinerant surgeons. But he gained well-merited credit by
his employment of ligatures for the arrest of bleeding in
a variety of conditions — not, however, in amputations, as
he appears to have avoided cutting operations. According
to the same authority, the circular pattern of trephine (the
kind which the surgeons of the present day prefer) was
first introduced by da Vigo. The following passage copied
from his ^' Practical ^ shows that he was familiar with the

use of the ear speculum; ** si ad solem speculo

instrumento aure ampliata.^^ Da Vigo died soon after
1517.

Bartolommeo Maggi, who was born at Bologna either in
1477 (Haeser) or in 1516 (von Gurlt), held the Chair of
Anatomy and Surgery in the medical school of his native
city, and then at a later date accepted the position of
private physician to Pope Julius the Third (1550-1555).
He held this position, however, only for a short time, as
he found that the climate of Rome did not agree with him.
His posthumous fame rests largely on the treatise which
he wrote on gunshot wounds and which was published by
his brother a short time after the former's death. His
treatise, says von Gurlt, is one of the best of those which

/

474 GROWTH OF MEDICINE

were published on this subject during the sixteenth century.
Henry the Second, King of France, expressed his gratitude
to Maggi for the care which he took of the wounded French
soldiers who fell into the hands of the papal troops at the
sieges of Parma and Mirandola. Maggi maintained firmly
the belief that gunshot wounds are either poisoned or
burned. His death occurred in 1552. The title of his
treatise on gunshot wounds is : ''De vulnerum bombardarum
etc.,^^ Bologna, 1552.

•Marianus Sanctus of Barletta near Naples (born in 1489,
died at some unknown date after 1550) is credited with
having been the first to publish a description of the so-
called ' ' apparatus magnus ' ' — the name given in those early
days to the method of extracting a calculus from the urinary
bladder through an incision in the perineum after a grooved
sound or director had first been passed into this organ by
way of the urethra. The title of the book in which this
description is given is the following: ^^De lapide renum
liber et de lapide ex vesica per incisionem extrahendo,^*
Venice, 1535. Marianus, however, does not claim to have
been the inventor of this method. Some writers give the
credit for this to Jean da Vigo's father, Bernardo di
Eapallo, who communicated a knowledge of the method to
Giovanni de Eomanis, who in turn instructed Marianus
Sanctus. It is believed, furthermore, by some writers that
Giovanni de Romanis was the inventor of lithontripsy^ — the
operation of crushing a stone in the bladder or urethra.
Laurent Colot, the famous French lithotomist of the eight-
eenth century, obtained his knowledge from a certain
Octavianus de Villa, a friend of Marianus Sanctus, and
then kept the matter secret for many years.

Fallopius, the famous anatomist of the early part of the
sixteenth century, does not appear to have attained equal
distinction in the field of surgery. So far as one may judge
from the portions of the text selected from his writings
by von Gurlt, Fallopius was a very conservative if not a
very timid surgeon, in this respect being not unlike Fab-

1 The modern operation known as litholapaxy.

DEVELOPMENT OF SURGERY IN ITALY 475

ricius ab Acquapendente. In the text to which reference
has just been made, I find a brief mention of a case which
passed under Fallopius' observation and which, perhaps,
is of sufficient interest to be recorded here. The patient's —
a German student's — finger had been nearly severed by
some cutting instrument, and the greater part of the
member remained attached to the hand only by a narrow
strip of flesh. **I stitched together the separated edges,
and at the end of three or four days I was astonished to
find that firm union between the separated parts had
already taken place. This result seemed to me like some-
thing miraculous."

Carcano Leone was born at Milan in 1536, his parents
being people of good social standing. After receiving a
thorough classical education, he began his medical studies
in his native city, under the guidance of Pietro Martire,
a pupil of Vesalius. He next continued his studies at the
University of Pavia, but eventually went to Padua, where
he enrolled himself among the pupils of Fallopius. After
a residence of two years in that city, he returned to Milan
and opened a medical school of his own. Upon the occasion
of the death of the Cardinal and Archbishop Carlo
Borromeo, whose remains now rest in the cathedral of
Milan, it was Carcano Leone who was invited to make the
postmortem examination. He carried on the practice of
his profession during a period of about twenty-eight years,
his death occurring — so far as may now be learned — in
1606.

Carcano Leone's reputation as a surgeon rests mainly
on the treatise which he wrote on the wounds of the head,
and which was published at Milan in 1583. From among
the numerous cases of this character which came under his
observation, and of which a certain number are reported
by von Gurlt, I have selected the very brief histories of
three that seem to me well adapted to serve as examples
of Leone's knowledge of surgery and also of his ability to
cope with problems of so serious a character. They reveal
the fact that he was a surgeon of excellent judgment, most
persevering, and very resourceful. Briefly told, the

476 GROWTH OF MEDICINE

accounts of the three cases to which I have referred read
as follows: —

Case I. — A small boy was hit on the right temple by a stone that
had been thrown by one of his companions. Unconsciousness
resulted and lasted for six days. On the seventh day signs of
returning consciousness manifested themselves, but inability to
speak persisted. By the end of another week the boy had already
made some efforts to speak, but his speech was incomprehensible.
After the twentieth day it was possible to understand a little of
what the boy was trying to say ; and from this time onward steady
improvement in this respect was recognizable from day to day;
but the boy's speech did not become quite normal until after the
lapse of about a year.

When Carcano Leone was called to see the patient he found
that the entire temporal muscle had been crushed and that almost
the entire right side of the head was occupied by a fluctuating
swelling. By making a free incision in the swelling Leone gave
exit to a large quantity of black coagulated blood. On the following
day, when he made an examination with the probe, he found that
the entire squamous portion of the temporal bone was in a fractured
state, one part of it overriding the rest. By the aid of elevators
he succeeded in lifting up the depressed part of the bone, but the
accomplishment of this result left a large gap between the opposite
edges of the fragments, and through this opening one could see
the movements of the dura mater. Complete healing took place
only after the lapse of twelve months.

When Leone reported the case to his former teacher, Fallopius,
the latter replied that he would not have had the courage to adopt
the course which his former pupil had pursued.

Case 11. — In another case the patient, a full-grown man, was
struck on the right temple by a highwayman with a heavy cane
which broke in two in the middle under the great force which the
assailant had employed. He was left lying on the roadside in a
state of unconsciousness until some passers-by discovered him and
carried him to his home. He remained unconscious for several
days. Before the physician was summoned aU sorts of measures
had been resorted to for the purpose of dissipating the swelling
in the temporal region, but without success. Leone, on arriving
upon the scene, made a free incision which afforded escape to a
large quantity of decomposing blood that appeared to be collected,
not between the muscle and the skin, but between the muscle and

DEVELOPMENT OF SURGERY IN ITALY 477

the bone. The latter was found to be fractured transversely and
depressed ; and, in order to lift it back to its proper level, it became
necessary first to incise the muscle transversely. At the end of
three months the wound had completely healed and the patient
had regained his health.

Speaking of the cases just narrated and of others of a
similar nature, Leone remarks that he has never had any
experience that would justify the fear expressed by Hip-
pocrates that convulsions are likely to result from dividing
the temporal muscle.

With reference to the value of trephining the skull in
cases of injury to the head, Leone narrates the following
experience : —

Case III. — A man was struck by a heavy stone on the upper part
of the forehead close to where the hair grows, and was thrown to the
ground by the force of the blow. Here he lay as if dead. When
Leone was called, a short time afterward, to see the patient he
found the skin unbroken except at one small spot, and from this
point he made an incision of such length that he was thereby
enabled to explore the surface of the skull. In this way he dis-
covered that there was a fracture which appeared to extend through
the entire thickness of the skull. He then, without further delay,
trephined the cranium over the line of the 'fracture. This was
followed by such a copious flow of blood that Leone was obliged
to adopt measures for arresting any further hemorrhage. During
the following fourteen days (the summer season then being at its
height) large quantities of decomposed and evil-smelling blood
escaped from the wound; but the dura mater gradually assumed
a more natural appearance, many splinters of bone were ejected,
and finally — at the end of forty days — the wound healed. (As no
further details are given in the text, it is fair to assume that there
were no sequelae of an unfavorable nature.)

The whole subject of injuries to the skull is treated in
a most thorough manner by Leone, and the book is pro-
nounced by Scarpa (1752-1832), the famous anatomist, the
best that, up to his time, had been written on the subject.
The three histories of cases which I have here reproduced
and which furnish such striking proof of what surgery
may accomplish when practiced by a man of good courage

478 GROWTH OF MEDICINE

as well as of good judgment, certainly justify the favorable
opinion expressed by Scarpa upon Leone's work.

Fabricius ab Acquapendente, of whom I have already
given some account on a previous page, was distinguished
not only as an anatomist and as a physiologist, but also —
which was true of his instructor, Fallopius — as a surgeon.
From his published writings, however, it appears very
clearly that, like Fallopius, he had a decided aversion to
the use of the knife; his activities as a surgeon being
restricted largely to the improvement of certain of the more
bloodless operations (for example, tracheotomy and thora-
centesis and operations for the relief of stricture of the
urethra). He also invented several new surgical instru-
ments and devised a number of machines for use in ortho-
paedic practice. He attached great value to the teachings
of Celsus and Paulus Aegineta, his writings containing
frequent and copious references to these authorities and
relatively few data based upon his own experience. In the
section which he devotes to the subject of wounds of the
abdomen, Fabricius confirms the opinion very generally
held by the ancients, viz., that a wound of the small intes-
tine is invariably fatal.

Gaspare Tagliacozzi was born at Bologna in 1546. He
studied medicine under Girolamo Cardano, Professor of
Medicine, first at Pavia and afterward at Bologna, and
received his degree (''Doctor of Philosophy and Medi-
cine") in 1570. Very soon afterward he began teaching
surgery, and a little later he also taught anatomy and the
theoretical part of medicine. In this work he was so
successful that in 1576 he was made a member of the
Faculty. He died on November 7, 1599, at the age of fifty-
three.

The Italian method of performing plastic operations,
says von Gurlt, had already flourished for about one
hundred and fifty years before Tagliacozzi took up the
subject in serious earnest and attained results of decided
scientific value. There are some doubts, however, as to the
precise degree of credit that should be awarded Tagliacozzi
for his share in the development of the operation which

DEVELOPMENT OF SURGERY IN ITALY 479

bears his name. The facts which throw some light upon
this question may be stated in the following paragraphs : —

(1.) Tagliacozzi 's Latin is not easy to understand, and he cer-
tainly does not furnish satisfactory information as to the manner
in which he learned the details of the operation which we are here
considering. Vesalius, Pare and other surgical authors of that
period throw no light upon that question and furnish erroneous
descriptions of the steps of the operation. Apparently they had
never witnessed one of that character. (Von Gurlt.)

(2.) The records seem to warrant the statement that, about the
middle of the fifteenth century a surgeon by the name of Branca,
who lived in the city of Catania on the southeast coast of Sicily,
devoted himself largely to the reconstruction of damaged or defect-
ive noses. At first he transplanted a flap from the forehead or
cheek; but afterward his son sought to improve the method by
utilizing a flap of skin taken from the arm. By this plan the
disfiguring of the patient's face was avoided. The son employed
the same method in repairing the lips and the ears. Pupils of the
latter carried a knowledge of the method to the Bojano (Vianea
or Vieneo) family in Tropea, Calabria, and from them it was
transmitted, about the middle of the sixteenth century, to Taglia-
cozzi and eventually to the medical profession in every part of
the world.

(3.) In 1581 there was published at Cracow, Galicia (formerly
Poland), a book which bore the title "Przymiot" and which gave
a most complete account of the disease syphilis in all its mani-
festations and complications. This book, in its original form, is
to-day one of the greatest bibliographical rarities; but a reprint
of the work was published in 1881 by the Warsaw Surgical Society.
In this volume Wojciech Oczko, the personal physician and secre-
tary of the Polish kings Stephan Bathory and Sigismund the
Third, discusses other surgical topics beside syphilis. He states,
for example, that Aranzio (or Arantius), who was Professor of
Surgery at Bologna at the time (1569) when he frequented that
medical school, was successful in making a new nose by trans-
planting a flap of skin from the patient's arm; and that he per-
formed this operation without injuring the muscles of the arm,
and also with perfect success as regards the creation of a straight
and shapely nose. "This statement," says von Gurlt, ''coming as
it does from an eye-witness who was at Bologna several years before
Tagliacozzi 's time, furnishes satisfactory proof that rhinoplasty
was successfully performed in that city several years before the

/

miiiiimimmmi^sm.

m
/r /i

1.(11 i m.

FIG. 21. THE MANNER IN WHICH THE SO-CALLED TAGLIACOTIAN OPERA-
TION FOR REPAIRING A DEFECTIVE NOSE SHOULD BE CARRIED OUT.

(From the treatise published by Tagliacozzi, Venice, 1597.)

DEVELOPMENT OF SURGERY IN ITALY 481

date of publication (1586) of Tagliacozzi 's earliest comments on
the subject, and that the credit for first bringing the operation to
the knowledge of European surgeons is due to Aranzio rather than
to Tagliacozzi. " The latter 's famous treatise on rhinoplasty ("Z)e
chirurgia curtorum per insitionem^^) was published at Venice in
1597.

(4.) Fabricius of Hilden, the distinguished German surgeon of
the sixteenth century, assures us that his teacher, Jean Griffon, at
that time the leading surgeon of Lausanne (but, at an earlier
period, of Geneva), performed the same operation in 1592. The
patient was a young Genevese woman whose nose had been cut
off by some soldiers belonging to the army of the Duke of Savoy
who were enraged at the resistance which she offered to their
familiarities; and the operation proved most successful, "the new
nose eliciting the admiration of all who saw it." Fabricius adds
that during the winter seasons, up to the year 1613, the tip of
this nose presented a somewhat purplish hue. The woman married
in 1603.

(5.) During the short lifetime of Tagliacozzi several tablets, on
which laudatory inscriptions were engraved, were erected in the
high school (archiginasio) of Bologna, and after his death a bust
that represented him holding a nose in his hand was erected in the
same building. Corradi, the medical historian (1833-1892), writes
that in his time both bust and tablets had disappeared. Taglia-
cozzi's remains were temporarily lodged in the cloisters of the
church of San Giovanni Battista, and the report was circulated
that, a few weeks after his death, a voice was heard saying that he
was among the damned. Thereupon the remains were removed
to the walls of the city, and the Tagliacotian method was soon
forgotten, to be revived only after the lapse of many years.

All the data which I have reproduced in the preceding
paragraphs seem to point to the conclusion suggested by
von Gurlt, viz., that Tagliacozzi was willing to accept for
himself a credit which belonged in reality to another, and
that there would be more justice in calling the famous
rhinoplastic method of procedure *'the Arantian operation"
than the Tagliacotian; especially as our knowledge of the
method adopted by the younger Branca is entirely too
vague to justify us in bestowing this honor upon him.

Giulio Cesare Aranzio (or Arantius) was born at Bologna
about the year 1530. He studied medicine first in his native

/

482 GROWTH OF MEDICINE

city, under the guidance of his uncle, Bartolommeo Maggi,
and then afterward went to Padua, where he may possibly
have been one of Vesalius' pupils. In 1548 he made, at
Padua, his first anatomical discovery — that of the musculus
levator palpehrae superioris. Before he was twenty-seven
years old he was chosen Professor of Medicine, Surgery
and Anatomy in the University of Bologna, and he filled
the position with distinction up to the time of his death on
April 7, 1589 — i.e., during a period of thirty-three years.

The part taken by Aranzio in the advancement of sur-
gery was apparently of small importance. He succeeded,
it is true (see remarks on page 479), in reviving the interest
of contemporary surgeons in the possibility of restoring
damaged parts of the human face by means of flaps taken
from the patient's arm. But I have not been able to dis-
cover that he made any other material contributions to this
department of the science of medicine. It is possible, how-
ever, that his plan of illuminating the interior of the nose
and of operating upon nasal polypi may possess some
measure of originality ; but I do not feel competent to decide
this question. As regards the procedure just referred to,
it may be stated briefly that Aranzio was in the habit, when
operating within the nasal cavity, of using by preference,
for illuminating purposes, the direct rays of the sun, which
were allowed to enter the room through a slit or hole in
the wooden window blind; and, when sunlight was not
available, he used as a source of light the rays emanating
from a lighted wax candle. In the latter case he increased
the brilliancy of the illumination by interposing between
the flame of the candle and the illuminated field, a glass
globe filled with water, — an idea which probably originated
with the goldsmiths or the shoemakers. The employment
of light reflected from a concave mirror supplanted this
method somewhere about the year 1866.

In Italy, during the sixteenth century, there were several
surgeons — ^uneducated empirics — who contributed not a
little to our knowledge of the radical cure of hernia; and
of this number the members of the Norsa family (from
Norsa, a small town in the district of Naples) were

DEVELOPMENT OF SURGERY IN ITALY 483

undoubtedly the best known and most experienced opera-
tors. Horazio Norsa, for example, is reputed to have
performed the radical operation (in combination with
castration) no less than two hundred times. It was this
same Horazio Norsa who, in the latter part of his career,
complained to Fabricius ab Acquapendente that, since the
wearing of trusses had become so common a custom as it
then was, the number of operations for the cure of hernia
had greatly diminished.

CHAPTER XXXVIII

THE DEVELOPMENT OF SURGERY IN SPAIN AND
PORTUGAL DURING THE RENAISSANCE

According to the authority of Morejon, who published
(1842-1852) an elaborate history of medicine in Spain and
Portugal, these countries almost rivaled Italy, during the
sixteenth century, in the number and excellence of their
physicians. But, so far as I am able to judge from the
record, very few of these men appear to have taken a strong
interest in surgery, and of these few there are only three —
Daza Chacon, Francisco Arceo and Amatus Lusitanus —
who left behind them treatises which seem to call for a
brief notice.

Dionisio Daza Chacon, who was born in 1503 at Valla-
dolid, about one hundred miles north of Madrid, received
his early training partly in his native city and partly at
the University of Salamanca. After being engaged for
some time in private practice he joined the imperial army
(Charles the Fifth) in the capacity of a field surgeon in
charge of a corps of three thousand men. In addition to
these troops there were six thousand English archers, in the
pay of the Emperor. At the two sieges in which these men
participated — the siege of Landrecy in 1543 and that of
Saint Dizier in 1544 — Daza Chacon acquired an extensive
experience in the treatment of both arrow and gunshot
wounds, for the number of those injured on those occasions
was very great. In 1545, after he had been chosen personal
physician of Charles the Fifth, he returned home by way of
Madrid, and distinguished himself greatly in 1547 by his
self-sacrificing attendance upon the victims of the Plague in
his native city. In 1557 he offered himself as a candidate for
the position of Surgeon-in-Chief of the hospital at Valla-

DEVELOPMENT OF SURGERY IN SPAIN 485

dolid, and, after passing with great credit the competitive
examination, he was given the appointment. During the
following six years he served that institution with con-
spicuous ability, and then accepted the position of private
physician to Prince Don Carlos, the son of Philip the
Second, King of Spain. Four years later he entered the
service of Don Juan of Austria (the natural brother of
Philip the Second), and accompanied this prince on his
sea voyages to various parts of the Mediterranean; being
with him, for example, on the occasion of the bloody sea
fight in the Gulf of Lepanto in 1571. On reaching the age
of seventy, Daza Chacon retired from active practice and
devoted himself to the writing of his great work on sur-
gery— ^'Practica y teorica de cirujia, en Romance y en
Latin/ ^ Valladolid, 1600; and several later editions. The
date of Chacon's death is not known, but it certainly
occurred before the publication of his book.

Von Gurlt says that Chacon 's treatise is distinguished by
the systematic and clear manner in which the author treats
the subjects with which he deals, and it shows him to be
well versed in the teachings of other writers on surgery,
that he is ready at all times to give them full credit for any
contributions which they may have made to this branch
of medicine, and that he is remarkably free from the super-
stitiousness which was so prevalent in his day. Of all the
treatises on surgery which have been written by Spaniards,
either during the sixteenth century or at a more recent
date, this work, says von Gurlt, is unquestionably the best.

The edition of the treatise published at Madrid in 1626
contains 922 pages — a large work. Among the reports of
cases published in Part II., there are several which possess
features of considerable interest, but I shall be able to
reproduce only one of them here: —

The young prince, Don Carlos, aged seventeen, while residing
temporarily at Alcala de Henares, plunged head foremost, in the
dark, down a steep staircase and struck his head against a closed
door. When the lad was picked up it was found that, at the back
of his head, there was an open wound about the size of a man's
thumbnail, that the surrounding scalp showed evidences of being

486 GROWTH OF MEDICINE

bruised, and that the pericranium in this region had been laid
bare. During the first three days following the accident the patient
manifested only a moderate degree of fever, but on the fourth
day the fever became more pronounced. The wound, which by
this time was discharging actively, presented at first a healthy
appearance, but it soon acquired an unhealthy aspect, and the
patient began to complain of numbness in the right leg. Vesalius,
the private physician of Charles the Fifth, the boy's grandfather,
was one of the many physicians who were called in to consult about
the treatment of this case; he was sent for on the eleventh day
following the accident. On the seventeenth day the wound was
enlarged and the bone carefully examined, but no evidence of a
fracture or a fissure was discovered. On the following day
erysipelas manifested itself on the head and neck and extended
downward until it had involved both arms. At the same time the
fever increased very markedly, and for five days the patient was
delirious. As by thi^ time there was ample reason for suspecting
that some intracranial injury had occurred, it was decided to
trephine the skull. The operation was performed on the twenty-
first day, but nothing of importance was discovered. The patient's
life was now evidently in great peril, and an unfavorable prognosis
was pronounced. Four days later, however, complete consciousness
returned. On the twenty-ninth day a quantity of pus was
evacuated from the very much swollen eyelids; and, three days
later still, the patient was found to be quite free from fever. On
the forty-sixth day he left his bed for the first time, and at the
end of ninety-three days the wound was found to have firmly
cicatrized.

[Some interesting details concerning the subsequent life of Don
Carlos will be found in Motley's "Eise of the Dutch Republic."
They suggest the possibility that his attacks of violent temper may
have resulted from the lesions produced by the accident narrated
above.]

Francisco Arceo was born, about the year 1493, at
Fregenal in the Province of Badajoz, Spain. It is not
known at what university or other educational institution
he received his early training in the science of medicine.
It is a well-established fact, however, that at quite an early
stage of his professional career he acquired great celebrity
for his skill in treating both surgical and internal maladies,
and that, as a consequence, patients flocked in large numbers

DEVELOPMENT OF SURGERY IN SPAIN 487

from all parts of Spain to consult him. Eather late in life
lie wrote two treatises — one on the treatment of wounds,
as well as on ulcers and syphilis, and another on the man-
agement of fevers. These two works were published at
Antwerp, in the year 1574, as a single volume, the author
being at that time, despite his advanced age (eighty), still
in vigorous health and able to practice with sMll both
branches of the science of medicine. In 1658 a second
edition of Arceo's two treatises was published at Amster-
dam; and even at an earlier date there were published an
English translation (1588) and a German version (1614).
A perusal of the chapter which he devotes to the treatment
of clubfoot gives the impression that Arceo was an excel-
lent surgeon — eminently practical in his choice of means
for securing certain results, and thoroughly familiar with
the extent to which he might depend upon the powers of
Nature to aid his efforts. The date of his death is not
known.

Amatus Lusitanus is the name by which the Portuguese
medical writer, Juan Rodriguez de Castel Bianco, is com-
monly known. He was born in the Province of Beira,
Portugal, in 1511, of Jewish parents, and studied medicine
at the University of Salamanca. After doing duty as a
surgeon in two of the hospitals of that city, he took up his
residence, for short periods of time, first in Antwerp and
then in Ragusa, Dalmatia, on the eastern coast of the
Adriatic. At this period of our history the Inquisition was
extremely active throughout the domains that were under
the rule of Charles the Fifth, and as a result Amatus soon
found himself obliged to abandon all his books, instruments,
etc., and flee for his life to Northern Greece. As the Turks,
who were in possession of that country, were perfectly
indifferent with regard to the religious beliefs of the Jews,
Amatus was allowed to settle down quietly for the rest of
his life at Thessalonica, in Macedonia.

During the later years of his career he published several
books on topics relating to the science of medicine — two
of them on materia medica and two on the cases of special
interest which had come under his personal observation

488 GROWTH OF MEDICINE

during the course of his practice. The latter work, which
is entitled '^Curationum medicinalium centuriae VII., "^
was printed in its entirety in Venice, in 1556 (2 vols.).
Von Gurlt speaks of Amatus as a cultivated scholar and
an excellent observer. Of the seven hundred cases reported
in this work only a very few are of interest to the surgeon.
Von Gurlt calls attention to the fact that, during the earlier
years of his practice, Amatus devoted a fair share of his
attention to surgery, but that subsequently he performed
no operations whatever; it being his rule to intrust this
work entirely to a regular surgeon or to a specialist.

In my search among the dozen or more histories of cases
selected by von Gurlt from the seven ''Centuries" (700)
of the complete treatise as suitably illustrating Amatus'
manner of reporting the cases which he had seen in practice,
the various methods of treatment which he adopted in his
efforts to relieve the diseases or injuries that came under
his observation, and the demeanor of the man in the pres-
ence of the ever-changing problems presented to the physi-
cian, I have succeeded in finding only four that seem to
furnish in even a slight degree the information which I
have just outlined. Unsatisfactory as these four reports
are in certain respects, — especially in their failure to reveal
to us the more strictly surgical capabilities of Amatus, —
they at least show that he was an able and conscientious
practitioner, and to this extent they possess value.

The first case reported in Century I. is that of a peasant girl,
aged thirteen, who, while walking barefooted in a field was bitten
by a viper. Amatus did not see the patient until three hours later,
but already at this early stage he observed many blue and red
patches, scattered over the leg and thigh of the side on which the
bite had been inflicted. Near the base of the foot there were two
quite black spots corresponding to the bites of the reptile; and
from the fact that there were only two such spots Amatus inferred
that the snake must have been a male viper, which has only two
poison fangs and is therefore less dangerous than the female which
has four. The symptoms which the girl experienced were faint-
ness, trembling and dizziness. As regards the treatment adopted,

1 The word ' * centuria ' ' is employed here in the sense of " a group of one
hundred."

DEVELOPMENT OF SURGERY IN SPAIN 489

the skin in the immediate neighborhood of the bites was scarified
and suction by the means of cupping glasses was employed ; after-
ward a plaster, which was composed in part of theriaca, was applied
to this region. The patient made a complete recovery.

In Century V., Amatus gives an account of a fatal case of ear
disease. The patient, a sickly-looking boy of eight who had been
affected for a long time with a discharge from one ear, presented
a non-sensitive lump on the side of the head. "As he began to
show signs of f everishness it was decided to incise the lump ; and
when the incision had been made, it was found that a large part
of the skull in this region had been destroyed by caries, as a result
of which there was left a cavity in the side of the head, and this
cavity was filled with a foul-smelling pus, debris, and granulation
tissue that apparently rested on the dura mater. Three days later
the surgeon- succeeded in removing from the cavity only a small
quantity of the sanious material. On the fourth day, after an attack
of convulsions, the patient died."

In Century VII. there is given an account of a man of the wealthy
class who had been exposed to an excessive degree of cold for so
long a time that he was literally almost half frozen. **As he was
being carried into the village he gave orders that an ox should be
slaughtered and that he himself should be snugly stowed away
inside the carcass of the animal as soon as its interior furnishings
had been removed. Thus he escaped freezing to death."

In the same century Amatus speaks of having seen a rather
interesting case of Filaria Medinensis (called by the Arabs "vena
medena") in a negro boy, eighteen years old, who had come to
Thessalonica from Memphis, Egypt. "The worm had caused the
production of an ulcer close to the boy's heel, and in this the
creature's head, which looked very much like a vein, was recogni-
zable. After the Turks had correctly diagnosed the nature of the
trouble an Arabian physician, who had managed to secure a pur-
chase on the worm, began rolling it up on a small stick. Gradually,
after the lapse of several days, he succeeded in uncoiling the animal
in its entire length (three cubits), as shown by the construction of
the end of the tail, and thus permanently freed the boy from his
trouble. The ancient authors express doubts as to the true nature
of the object found in these ulcers, but I, Amatus, having examined
the slender white creature and having witnessed its curved outlines
as it projected itself outside the opening, do vouch for the fact
that it possesses all the characteristics of a true worm."

2 Not Amatus, but a specialist. See remark near the top of page 488.

/

CHAPTER XXXIX

THE DEVELOPMENT OF SURGERY IN FRANCE
DURING THE RENAISSANCE.— PIERRE FRANCO

Von Gurlt speaks of Pierre Franco as *'one of the most
skilful surgeons and at the same time one of the most
original medical writers of the sixteenth century." He
and his contemporary, Ambroise Pare, were of French
birth, and to France therefore belongs the conspicuous
distinction of having contributed to medical science during
the Renaissance two of its most illuminating and efficient
laborers. These men, who were the leading operative
surgeons in France during the first half of the sixteenth
century, did not owe their education as physicians to the
official training provided by the Medical Faculty, but partly
to the men who were classed as barbers and surgeons, or
barber-surgeons {College de St. Come), and still more to
their own efforts. They gathered practical knowledge
wherever they might — ^largely from their official connection
with armies during the progress of different wars. Fur-
ther details with regard to their personal characters and
the principal events of their professional careers will be
furnished in the following brief sketches.

Pierre Franco. — Pierre Franco was born in the village
of Turriers, in Provence (now the Department of Basses-
Alpes), about the year 1500. He received his instruction
in surgery from itinerant lithotomists, operators for cata-
ract, hernia-healers and men of that class ; and it is quite
likely that, in the early days of his professional career in
Provence, he was himself a practitioner of this humble
type. At a somewhat later date he left the southern part
of France and took up his residence in Switzerland, first
at Berne and then at Lausanne. He probably left Provence

DEVELOPMENT OF SURGERY IN FRANCE 491

because, in the early part of the sixteenth century, the
Protestants of that region were being subjected to every
form of persecution; and it is almost certain that Franco
belonged then to the Reformed Church, for he accepted the
salaried office of City Surgeon at Berne, the authorities of
which city were bitterly opposed to everybody and every-
thing connected with the Roman Catholic Church. Franco
held the office named during a period of ten years, the first
part of the time at Berne, and afterward at Lausanne,
which latter city was then under the control of the Bernese
Government. He was a very close observer, a most enthu-
siastic student of his art, and a man of intensely religious
nature. Malgaigne, the distinguished editor of the modern
edition of Fare's writings, speaks thus of Franco: '*I
have no intention of writing here the history of this man
who was endowed with such a fine surgical genius ; I may
say, however, that his was a life devoted entirely to the
advancement of surgery as a science."

As an operative surgeon, says Edouard Nicaise, Franco
ranked higher than any of his contemporaries. Strange
as it may appear, Ambroise Pare frequently refused to
take charge of cases in which an operation for stone in the
bladder, for hernia, or for cataract was required, whereas
Franco owed much of his reputation to the success which
he had in operating upon these three classes of cases. The
latter, furthermore, did most of his work on patients who
belonged to the middle class, and consequently his opera-
tions were characterized by very little of the eclat which
marked a large part of the work done by Pare, who from
the very beginning was befriended by Royalty and the
Court circle. At the same time, says Nicaise, Franco did
more than any other man of that period to enrich surgery
with new discoveries.

Franco has written only two treatises. The first one,
which was published in Lyons, France, in 1556, bears the
title: "A Small Treatise on the Operative Treatment of
Hernia" — one of the most important departments of sur-
gery (a book of 144 pages, 8vo). The second work, which
was issued in 1561, also at Lyons but by a different pub-

492 GROWTH OF MEDICINE

lisher, bears the title: ^'Traite des hernies contenant une
ample declaration de toutes leurs especes, etc.^' (a book of
554 pages, 8vo). This work goes very thoroughly into the
subject of hernia in all its bearings, and also deals with
several other important surgical topics, such as genito-
urinary diseases (in both the male and the female), affec-
tions of the eyes, hare-lip, tumors, wounds in general, dis-
locations, fractures, amputations, etc. ; in short, it is a fairly
complete and decidedly original treatise on general surgery.
When Franco wrote the smaller work (that of 1556), he
was settled at Lausanne; but in 1561 he was living in
Orange, which at that time was the capital of a Principality
that belonged to the House of Nassau.^ A few brief cita-
tions from the larger of the two treatises will suffice to give
our readers some idea of the manner in which Franco deals
with the subject-matter of the book.

Franco, says von Gurlt, was one of the first surgeons —
perhaps the very first — to perform the operation required
for the relief of strangulated hernia and at the same time
to furnish a description of the manner in which it should
be performed. After mentioning the fact that the strangu-
lation of a portion of the intestine is attended with consid-
erable danger to the patient's life. Franco proceeds to
consider the subject in greater detail: —

Owing to the large amount of the fecal matter and gas contained
within the portion of the intestine that is imprisoned in the scrotum,
and also owing to the inflamed condition of the parts, it is frequently
not possible to push the bowel back through the narrow aperture
in the peritoneum; and this condition of things is apt to be
aggravated by the constipation or by the efforts at vomiting that
frequently accompany such strangulation. The vomiting, it is true,
may in certain cases facilitate the desired reduction, but in others
it does harm, especially by forcing more fecal matter into the
scrotum. If the conditions described are permitted to continue
unrelieved, death may certainly be expected to result. In a few
cases the timely administration of medicine internally may over-
come the difficulty, but, if this measure fail to produce the desired

1 Orange, whieli is only a short distance from Avignon and Tnrriers, was
ceded to France in 1713.

DEVELOPMENT OF SURGERY IN FRANCE 493

result, recourse must be had to surgery — ^not, however, if already
the scrotum and neighboring genital parts have changed their
color to a black, livid, bluish or some other unnatural hue, or if
the hernial tumor manifest a round rather than an elongated
shape, for all these signs are harbingers of death ; and, as further
unfavorable signs, should be reckoned a livid or black mucous
membrane of the patient's mouth, contracted nostrils, and an
appreciably sunken condition of the eyes. But if, on the other
hand, the scrotum possess a natural color and if it have not a
spherical form but rather an oval shape, then it is proper, after
a failure to secure the desired reduction by the internal use of
medicine, to resort to a surgical operation.

For the proper performance of this operation the surgeon should
be provided with a nicely rounded metal staff, flat on one side, and
a little larger than a goose's quill. [Fare's grooved sound or
director, says von Gurlt, had not yet at that time been invented,
and this staff was intended to serve, in a crude fashion, the same
purpose,] The first step is to make an incision in the upper part
of the scrotum, the direction in which it is to be carried being
toward the symphysis pubis. When the hernial sac is reached the
staff is introduced into the slit and pushed upward between the
wall of the sac and the fleshy part of the penis, the flat side of the
instrument being kept uppermost, as it is upon this surface that
the cutting with the scalpel or the razor is to be done. After the
end of the staff has been pushed well upward the flesh of the
scrotum is to be divided upon the flat surface of this instrument ;
all danger of injuring the intestine being thus avoided. Then the
attempt should cautiously be made to reduce or replace the intes-
tinal folds. But if these efforts fail, — owing to the excessive dis-
tension of the bowel or because the constricting band has not yet
been sufficiently relaxed, — then the following steps should be
taken: — Grasp the spermatic cord {^'didymis^'), lift up its
enveloping membranes one by one with hooks, and divide each one
of them completely upon one's finger nail, up to the point where
the intestine is encountered. Then, having established, between
the intestinal wall and the membranous coverings of the cord, an
aperture large enough to admit the end of the metal staff, push the
instrument onward and upward while at the same time it is held
as it were balanced in the air, so that early warning may be com-
municated to the holding fingers in case the instrument, as it
travels onward, should become caught in the folds of the intestine —
an accident, however, which the slippery nature of the outer sur-

/

494 GROWTH OF MEDICINE

face of the intestine renders improbable, but which nevertheless
may occur if at any point there happen to be a break in the con-
tinuity of the tissues. As the next step in the operation the cord
should be completely divided high up (the incision being made
upon the staff) close to the opening in the peritoneum through
which the folds of the intestine forced their way, in the first instance,
into the scrotum; but the surgeon must, without fear of doing
harm, and remembering that he is dealing with conditions of a
desperate nature, see to it that the opening made in the peritoneum
is amply large. Finally, with the aid of a soft piece of linen he
should return the folds of the intestine to the peritoneal cavity, etc.
[The remaining portions of the description are of minor importance
and may well be omitted here.]

Franco, speaking of those cases in which a portion of the
omentum is found projecting into the hernial sac, lays great
stress upon the importance of "not doing what many a
surgeon has done in the past and what not a few are still
doing in our time, viz., simply cutting off the imprisoned
distal portion of this membrane and returning the re-
mainder to the peritoneal cavity without first ligating the
divided blood-vessels and then cauterizing the cut surface ;
the danger being that a failure to take these steps frequently
leads to a fatal hemorrhage into the peritoneal cavity — an
occurrence which actually happened to one of our most
experienced surgeons in a case of enterepiplocele. ' '

There were certain operative procedures in which Franco
took a greater interest than in others. Thus, for example,
he was particularly fond of operating for the relief of
cataract, and the results which he obtained were excep-
tionally favorable (180 cures out of a total of 200 cases
subjected to operation). Von Gurlt quotes him as saying : —

If I had to choose between operations for the cure of cataract
and abandoning all the rest of my surgical practice, I should prefer
to adopt the latter course, so highly do I estimate the amount of
good which I can do in this line of work, so very important does it
appear to me, and so small is the amount of labor and worry which
it entails.

Franco was also greatly interested in the cure of stone
in the bladder, and it was while treating cases of this

DEVELOPMENT OF SURGERY IN FRANCE 495

character that he invented the very important surgical
procedure known in France as the ''Franconian operation
for stone in the bladder" (hypogastric cystotomy, supra-
pubic lithotomy). Here is the account which he gives of
the circumstances under which he was led to devise this
method of removing a stone from the bladder : —

1 will mention here an experience which I had on one occasion
when I tried to remove a calculus from the bladder of a boy about
ten years of age. The stone was about as large as a hen 's egg and
resisted all my efforts to extract it by way of the incision made
in the perinaeum. Being in a quandary as to how I should proceed
next, and the parents and friends being greatly demoralized by
the suffering to which I was unavoidably subjecting their child, —
they maintained, I should add, that they would rather have him
die than be subjected to such awful suffering ; — and being influenced
also by the thought that I could not afford to have it charged
against me that I was not able to extract the calculus, I deliberately
decided that I would make an opening above the pubic bone, and
would remove the stone in this manner. Accordingly I incised the
skin above the pubes, a little to one side of the base of the penis,
and carried the knife through the soft tissues down to the calculus,
which I had simultaneously pushed upward by pressing the fingers
of my left hand against the perinaeum, while at the same time my
assistant made counter-pressure against the stone by firmly com-
pressing the abdominal wall above the object. This method of
extraction proved successful.

In due time the wounds healed firmly and the patient was re-
lieved of his trouble, but only after a long and most serious illness.

Franco does not appear to have performed the supra-
pubic operation for the extraction of a cystic calculus more
than once (the case just narrated), and he carefully refrains
from recommending it to other physicians. Most surgical
authors, says Edouard Nicaise, blame Franco very strongly
for not having dared to recommend his suprapubic opera-
tion. **But I do not agree with this judgment; Franco
should rather be praised for his prudence in not imme-
diately announcing to the world his invention of an impor-
tant surgical operation."^

2 In the absence of a more fitting place in which to speak of the employ-
ment of urethral bougies, it seems permissible to state here that the first

496 GROWTH OF MEDICINE

The subsequent history of suprapubic lithotomy shows
that Franco was laboring under an exaggerated idea of
the dangers attending this operation. The comments of
Pascal Baseilhac — a nephew of '^ Brother Cosmas" (the
famous French lithotomist of the early part of the eight-
eenth century) and himself a skilled lithotomist — are worthy
of being repeated here. He says (p. 318 of his ^^Traite sur
la lithotomie/^ Paris, 1804) : *' Franco based his unwilling-
ness to recommend the operation of suprapubic lithotomy
on the belief which was then widely prevalent, and which
still persists even in our time (middle of the eighteenth
century), that the making of an incision into the main body
of the urinary bladder is sure to prove fatal, a belief
which experience and observation have now shown to be
unwarranted. ' '

The Franconian operation, the great value of which was
not sufficiently appreciated by its inventor nor by contem-
porary surgeons, was revived in 1719 by an Englishman,
John Douglas, the distinguished surgeon of Westminster
Hospital, London, and the brother of James Douglas — the
anatomist who in 1730 described so minutely the relations
of the peritonaeum to the bladder (Douglas' cul-de-sac).

In the case the history of which has just been narrated,
the circumstances attending the invention of the operation
known to-day as suprapubic cystotomy^ or ''suprapubic
lithotomy, ' ' were certainly of such an unfavorable character
as to call for the display of an unusual degree of courage,
wisdom, patience and manual skill on the part of the surgeon
in charge; and it was through a careful consideration of
these facts that Edouard Nicaise was led to award such
high praise to Franco for the work which he had done.
Scarcely less remarkable is the talent which the latter

mention (in medical literature) of these instruments occurs in Chapter XV.
of the treatise of Guainerio, Professor of Medicine at the University of Pavia.
This -work, which was first published in 1439, bears the title: "Practica
Antonii Guainerii," ajid a later edition was issued at Venice in 1508. Speak-
ing of a case of stone in the bladder, Guainerius says: "And if the urine

does not flow from the bladder introduce a slender flexible rod of tin

or silver into the urethra."

8 Franco calls it the ' ' high operation " or " hypogastric lithotomy. ' '

DEVELOPMENT OF SURGERY IN FRANCE 497

displayed in the invention of a forceps (Fig. 22) strong
enough to crush all but the hardest calculi and yet so
cleverly planned that it is practicable, while the crushing
end of the instrument is lying inside the bladder, to separate
the blades sufficiently far apart to render possible the

FIG. 22. PIERRE FRANCO'S FORCEPS FOR CRUSHING
CALCULI IN THE URINARY BLADDER.

(From Edouard Nicaise's Pierre Franco-, Paris, 1895.)

a, closed; b, open.

grasping of the stone between the jaws of the instrument
without at the same moment injuriously crushing the soft
parts in the narrow channel of the wound or opening.*

< After I had written the preceding description of Franco 's new piethod of
extracting a calculus from the urinary bladder, I learned, from Haeser's
account of the surgical writings of Susrutas in the Ayur-Veda (Sanscrit), that
already before the Christian era (the exact date is not known) the surgeons of
East India had performed this very operation. This fact, however, could not
possibly have been known to Franco, who — so far as modern surgeons are
concerned — should continue to be looked upon as the real inventor of supra-
pubic cystotomy. — Author.

/

498 GROWTH OF MEDICINE

In Franco's day the belief was widely prevalent that
there were remedies which possessed the power of dis-
solving a cystic calculus. His own opinion in regard to this
matter is expressed in the following words: ''I am aston-
ished that there should be many men who do not hesitate
to undertake the disintegration and pulverization of a
stone in the bladder by the employment of remedies which
are either to be administered by the mouth or to be injected
per urethram into that organ." He adds that a remedy
strong enough to dissolve even the softer stones would
become so changed and weakened in passing through the
various organs which it must traverse on its journey from
the mouth to the bladder that it could not possibly produce
the desired effect; nor could a chemical solution strong
enough to dissolve such a calculus be injected into the
bladder by way of the urethra without either causing
inflammation and ulceration of the walls of that organ or
promptly exciting muscular contraction that would effect-
ively expel the solution.

This seems to be an appropriate place in which to state
that lithotrity was practiced at an earlier date by Antonio
Beniveni (1440-1502), a Florentine physician whose writ-
ings reveal him to have been a man of a very practical and
unprejudiced type of mind, a very clear writer, and a
practitioner of wide experience. He also deserves credit
for having been the first surgeon to revive the operation of
tracheotomy, a procedure which was carried out by Antyllus
fourteen centuries earlier, but which appears to have been
forgotten during this long interval. He saved a patient's
life by means of the operation.

The date of Franco's death is not known.

CHAPTER XL

THE DEVELOPMENT OF SURGERY IN FRANCE
(Continued).— AMBROISE PARE

Ambroise Pare was born, about the year 1517, at Laval,
a small town in the Department of Mayenne, France. His
father was probably the valet and barber of the Count of
Laval. He went to Paris in early manhood and spent three
years, at this period, in fitting himself for the career of a
surgeon. He attended lectures on anatomy and surgery,
did a certain amount of dissecting, served for over two
years as a surgeon's assistant in the great hospital of
Hotel-Dieu, made notes of some of the cases which he saw,
and was occasionally permitted to prescribe for patients
and even to perform some minor operations. From 1536
onward, nearly up to the time of his death, he was almost
continuously engaged, in the capacity of a surgeon, in
accompanying different French armies on their military
expeditions. His professional title at first was that of
** barber," but he doubtless very soon discovered that, if
he wished to advance, it would be absolutely necessary for
him to secure a higher title. Accordingly, in 1541, he and
his friend Thierry de Hery presented themselves for, and
passed successfully, the required examination and were
accepted as ''master-barbers." It is an interesting fact
that, during his long professional career. Pare was Chief
Surgeon to four Kings of France in succession — first to
Henry the Second (1547-1559), next to Francis the Second
(1559-1560), then to Charles the Ninth (1560-1574), and
finally to Henry the Third (1574-1589). The last-named
King bestowed upon him the additional honor of ''Coun-
cilor to his Majesty." He also served, during a certain
period of his career, as an attending surgeon at Hotel-Dieu.

/

500 GROWTH OF MEDICINE

The three large volumes of Fare's writings (Malgaigne's
edition) are filled with the rich experience which this great
surgeon gained in the course of a large private practice
and in the field expeditions and sieges conducted during
the reigns of these Kings. Interspersed among the reports
of cases and descriptions of operations are to be found not
a few comments of a more general character and some
biographic details which add greatly to the charm of the
work as a whole, and which at the same time make it possible
to form a general idea of Fare's traits of character. On
almost every page one finds statements which reveal the
fact that he weighed almost all the duties of his daily life
in a profoundly religious manner. He showed himself
warmly sympathetic for all those whose ailments he was
called upon to treat, and he was always as ready to bestow
his best services upon the Eoman Catholics as upon the
Huguenots — to which latter denomination (if we may so
call it) he himself is commonly reported to have belonged.
It seems to me more probable, however, that he was a
liberal-minded Roman Catholic rather than a Frotestant,
for there is trustworthy evidence showing that all his ten
children were baptized in that faith and that he himself,
nineteen years before the night of Saint Bartholomew
(August 24, 1572), held the office of ^^Pathe'' in the church
of the parish in which he lived. Another prominent trait
of Fare's character was the modest estimate which he placed
upon his own professional achievements. One of his say-
ings, which occurs a number of times in his writings and
which has since become famous, is this : —

Je le pansay, et Dieu le guarist.

[I dressed his wound and God caused it to heal.]

Some of the other sayings attributed to his pen and
printed under the heading *' Surgical Canons and Rules,"
at the end of Book XXVI., are characterized by a homely
type of wisdom which seems to have have secured for them
a permanent place in French literature. I give here in the
form of English translations six or seven of the more
striking specimens : —

DEVELOPMENT OF SURGERY IN FRANCE 501

■ Mere knowledge without experience does not give the surgeon
much self-confidence.

Small will be the influence exerted by him who chooses surgery
as a career simply for what he may make out of it.

The frequent changing of physicians is not likely to bring com-
fort to the patient.

The facts already discovered are few in comparison with those
which are yet to be brought to light. We must not allow ourselves
to lie down or fall asleep under the impression that the ancients
knew all or have divulged all that is worth knowing. What they
have accomplished should be utilized by us as a sort of scaffolding
from which a more extensive view may be obtained.

In another place Pare expresses the same sentiment in
a somewhat different form, as follows: —

My professional brethren must not expect to find any new and
startling facts [Pare is speaking here of his treatise on surgery],
but simply here and there some little addition to our previous stock
of knowledge; for the good Guy de Chauliac has taught us that
we are like the child who sits astride the giant's neck; that is, we
can see all that he sees and just a little more — or, in other words,
we are able, through the aid afforded by the writings of our prede-
cessors, to learn all that they have learned, and may at the same
time acquire a little further knowledge through our own obser-
vations.

A remedy that has been thoroughly tested is better than one
recently invented.

An injury which opens a large blood-vessel is likely to lead the
victim of such a wound to the tomb.

It is always wise to hold out hope to the patient, even if the
symptoms point strongly to a fatal issue.

All through his professional career, but more especially
during the later years. Pare was repeatedly annoyed by
the efforts which the Medical Faculty made to bring him
into disrepute. These men were bitterly jealous of him on
account of the great favor which he enjoyed at Court, and
so they adopted every possible means to injure his repu-
tation. When the complete collection of his writings was
published in 1575, they petitioned the authorities not to
allow these ** works of a very impudent and ignorant man"

502 GROWTH OF MEDICINE

to be sold until they should have received the official
sanction of the Faculty. One of Fare's chief offenses, as
it appears, was that of not writing his treatises in Latin,
and among the twenty-nine specifications of his short-
comings was that of plagiarism. (See remarks on this
subject further on.)

In his efforts to extend his knowledge of the science of
medicine, and in particular to learn what the ancients had
written on the subject. Fare soon discovered that many
obstacles stood in his way. He did not allow himself,
however, to be discouraged by this fact, but set to work,
without delay and in his usual resolute fashion, to remove
them. He found, in the first place, that all the available
treatises of the ancient medical authors were written in
Latin, a language of which he possessed scarcely any knowl-
edge. So he was obliged to hire men to translate for his
o^Ti use large portions of these books. Then, at a later
date, after he had begun to accumulate notes for the
treatises in which he proposed to publish his own expe-
riences and his own views about the surgical topics in which
he was interested, he saw clearly that suitable pictorial
illustrations would add materially to the value of the written
text, and he therefore did not hesitate to spend a consider-
able sum of money — Malgaigne says three thousand
livres — ^in having the needed drawings made. Fare was
also in no small degree a public benefactor, for he purchased
the formulae of some of the more valuable of the remedies
employed by the leading charlatans, in order that he might
print them and so place them within the reach of everybody.

Pare gives the following picturesque account of his first
experiences as an army surgeon in actual warfare: —

In 1536, he says, I accompanied the large army sent to Turin
by Francis the First, King of France, to retake certain castles and
fortifications which were held at that time by the troops of the
Emperor Charles the Fifth. My official position was that of
surgeon to the foot soldiers; and when our men took possession of
Susa, after the enemy had been defeated, I was among the first
to enter the city. Our horses rode rough-shod over the dead bodies
lying on the roadway, and over the bodies of many who were simply

DEVELOPMENT OF SURGERY IN FRANCE 503

wounded. It excited my compassion strongly to hear the cries of
those who were thus subjected to great additional suffering, and
I could not help wishing that I had never left Paris. Once actually
in the city, I began to look around for a stable in which the horses
of myself and my orderly might find shelter. The one I entered
contained the corpses of four soldiers who had presumably died
there, and three badly wounded men who were still alive, but whose
faces were greatly disfigured by the wounds which they had received,
and who — as we soon learned — were unable to see, hear or speak.
An old soldier who entered the stable at that moment, and whose
pity was excited by what he saw, asked me if it would be possible
to save the lives of the men who were so badly injured. I replied
' ' No. ' ' He thereupon proceeded, without the least excitement and
with due gentleness, to cut the throats of all three. At the sight of
this act, of what seemed to me to be great cruelty, I exclaimed,
"You are a wicked man!" His reply was: "I pray God that,
if it should ever be my fate to be situated as these three men were
when I entered the stable, there may be somebody at hand who will
do to me what I have just done to these men, and will save me from
a lingering and painful death."

When the fighting was entirely over, we surgeons had much work
to do. I had not yet had any personal experience with the treatment
of gunshot wounds, but I had read in Giovanni da Vigo 's work that
such injuries should be considered poisoned wOunds, by reason of
their contact with gunpowder, and that the correct way of treating
such wounds was to cauterize them with oil of sambucus (elder
flowers) that was actually boiling and to which a little theriaca had
been added. At first I hesitated somewhat about carrying out this
practice, but after watching the other surgeons, in order to learn
exactly how they applied the boiling oil, I plucked up my courage
and did exactly what they did. My supply of oil, however, soon
gave out, and I then decided to use as a substitute a healing prepa-
ration composed of yolk of Ggg, oil of roses, and turpentine. I
slept badly that night, as I greatly feared that, when I came to
examine the wounded on the following morning, I should find that
those whose wounds I had failed to treat with boiling oil had died
from poisoning. I arose at a very early hour, and was much sur-
prised to discover that the wounds to which I had applied the egg
and turpentine mixture were doing well ; they were quite free from
swelling and from all evidence of inflammatory action; and the
patients themselves, who showed no signs of feverishness, said that
they had experienced little or no pain and had slept quite well.

/

504 GROWTH OF MEDICINE

On the other hand the men to whose wounds I had applied the
boiling oil said that they had experienced during the night, and
were still suffering from, much pain at the seat of the injury ; and
I found that they were feverish and that their wounds were inflamed
and swollen. After thinking the matter over carefully, I made
up my mind that thenceforward I should abstain wholly from the
painful practice of treating gunshot wounds with boiling oil.

In 1545, when he was about twenty-eight years of age,
Pare was sent as a military surgeon to Boulogne-sur-Mer,
which at that moment was being besieged by the French.
In 1544 the city had been captured by the army of Henry
the Eighth of England, and fighting of a desultory character
was in progress between the besiegers and the besieged at
the time of Fare's arrival. He had not been there a long
time when he was asked to see professionally Francis of
Lorraine, Duke of Guise, who had been seriously wounded
by a lance in a recent encounter with the enemy. The metal
head of the weapon, under the impulse of a glancing blow,
had penetrated the skin just above the right eye, had then
traveled toward the left side and in a slightly downward
direction, along the surface of the skull, and had finally
come to rest at a point behind and below the left ear, near
the nape of the neck. When the lance had penetrated thus
far the wooden shaft broke in two, leaving the metal head
in its entirety and a part of the shaft so firmly lodged in
the wound that great force had to be employed before it
was found possible, with the aid of strong pincers, to ex-
tract it from its bed. An examination of the injured parts
then showed that there had been some fracturing of the
bony structures and extensive laceration of the arteries,
veins, nerves, etc., but that the left eye had apparently not
been seriously damaged. The onlookers were naturally
impressed with the belief that the Duke could not possibly
recover from such a slashing of the face and head; and
Pare himself was careful at first not to commit himself to
a prognosis of too favorable a nature. However, he treated
the wound with the greatest care and in the course of a few
weeks had the satisfaction of seeing his patient restored
to perfect health, but with a deeply scarred face.

DEVELOPMENT OF SURGERY IN FRANCE 505

As can readily be imagined, this experience proved a
splendid triumph for Pare, and speedily brought him into
great favor at Court and among the nobility throughout
France.

For several years subsequent to these events. Pare
continued to serve actively as a surgeon in the frequent
wars which took place between the royal troops of France
and the armies of other European monarchs. In 1552,
when he was thirty-five years of age, his rank in the army
was raised to that of ''Surgeon to the King," the entire
medical staff of that period consisting of twelve surgeons
of this rank. In 1554 he was admitted to the College de
Saint Come in Paris, the highest professional honor to
which a barber-surgeon might aspire; and in 1563, after
the siege of Rouen, he received the appointment of "First
Surgeon to Charles the Ninth." After the latter 's death,
Henry the Third also appointed Pare to the same position
in his Court. Thus, from almost the very beginning of his
professional career to the time of his death. Pare was
honored in every possible way by four successive Kings
of France. It was Charles the Ninth, however, who appears
to have taken a greater interest in Pare's prosperity than
did either of the other three Kings. It was at Charles the
Ninth's request, for example, that the brother-in-law of the
Duke of Ascot, the Marquis of Auret, sent for Pare to
undertake the treatment of a wound which he had received
from a harquebus ball seven months previously. Pare
gives the following account of this interesting case which
foreshadows — for example, in the changing of the patient's
bed and linen and keeping him entertained during convales-
cence— the best modern hospital nursing: —

On arriving at the Chateau of Auret, writes Pare, which is
located not far from Mons in Belgium, I learned that the harquebus
ball had entered the thigh near the knee, had done considerable
damage to the soft parts, arid had fractured the femur. When I
was ushered into his bedchamber, I found the Marquis very much
emaciated, his eyes deeply sunken in their sockets, his skin hot
and of a yellowish hue, and his voice feeble like that of man very
near to death The leg was drawn up against the wall of

506 GROWTH OF MEDICINE

the abdomen, and two large bedsores were visible posteriorly — one
near the root of the spine and the other somewhat higher up. Thus
it was impossible for the patient to assume any posture in which

he would be free from suffering All things considered, it

did not seem to me that the Marquis could possibly recover from
such a combination of bodily ills. Nevertheless, to give him some
encouragement, — for he was very low in spirits, — I told him that,
with the aid of God and the assistance of his regular medical
attendants, I would soon have him on his feet again

After dinner, in the presence of the Duke of Ascot, a few friends
of the family, and the assembled physicians and surgeons, I ex-
pressed considerable surprise that free openings had not been made
in the Marquis's wounded thigh, in which bone caries and decompo-
sition of the resulting discharge were already well established.
The medical attendants replied that the patient was unwilling to
submit to any such measures, and that he had even forbidden them
to substitute clean linen bedclothes for those which were soiled and
which had not been changed during the previous two months

When the consultation had come to an end and the local medical
attendants had given their full approval of the different measures

which I recommended, I proceeded to carry them out

without further delay.

Two or three hours after the completion of this operative work
I instructed the house servants who were in immediate attendance
upon the Marquis to place alongside his bed a second one equipped
with a soft mattress, over which a fresh linen sheet, etc., had been
spread. The transfer from one bed to the other was easily effected
by a strong attendant, and when the change had been made the
Marquis manifested great contentment. Two feather pillows were
so placed under his back and loins that no pressure whatever would
be made upon his bedsores. A refreshing sleep of four hours'
duration followed the adoption of these different measures, and
there was much rejoicing in the entire household.

After a course of treatment lasting several weeks, Pare
says : —

Under this treatment the fever steadily diminished, the pain grew
less and less, and the patient 's strength increased. When the proper
moment arrived, I advised the Marquis to engage the services of
some musicians (players on stringed instruments) and one or two
comedians, in order that his spirits might be cheered by occasional
entertainments of this character. Already at the end of one month

DEVELOPMENT OF SURGERY IN FRANCE 507

we found it practicable to carry him in a chair into the garden and
as far as the entrance gate, where he could watch the passers-by.
When it became known among the peasants that he was in the
habit of sitting close to the highway, they came from far and near
to sing and dance in groups for his entertainment. He was greatly
loved by both the common, people and the nobility.

At the end of six weeks the Marquis was able to get about on
crutches, and two weeks later still I bade him good bye and returned
to Paris. Before I left he presented me with a gift of great value,
and the Duchess of Ascot insisted on my accepting a beautiful
diamond ring as a mark of her appreciation of the services which
I had rendered her brother.

Among the varied experiences which fell to the lot of
Pare during his association with Charles the Ninth, there
is one which throws a little additional light upon the man's
manner of promptly dealing with an event which, without
such promptness of action, might have led to serious
consequences.

He was passing through Montpellier one day in company
with the King, when he stopped for a few minutes at the
shop of an apothecary for the purpose of ascertaining how
he preserved alive the vipers which he used in compounding
the remedy which is called * * theriaca, ' ' and which has been
used from time immemorial as an antidote to the poison
of venomous serpents. The apothecary placed before him
a glass jar in which were kept a number of these reptiles ;
and, when Pare took one of them up in his fingers in order
to obtain a better view of his fangs, the reptile bit him near
the tip of his index finger, between the nail and the flesh.
The pain which immediately followed was severe, partly,
as Pare explains, because the tip of the finger is a very
sensitive part, and probably also on account of the irritating
effect of the venom. Then, to quote Pare's own words,
* ' after making firm pressure upon the soft parts above the
wound, to prevent the poison from traveling upward, I
crowded the skin downward in the hope of forcing as much
of the venom as possible out of the finger. While doing
these things I instructed the apothecary's assistant to mix
some old theriaca with brandy, and then to apply a pledget

508 GROWTH OF MEDICINE

of cotton, saturated with the mixture, over the wound. In
the course of a few days, and with no other treatment, all
effects of the bite disappeared."

In 1536, two years after his first experience with actual
warfare in the vicinity of Susa, Italy, and while he was
still very young to assume so great a responsibility. Pare —
as we learn from the text of Chapter 28, Book X., of
Malgaigne's edition — performed the operation of exarticu-
lation of the elbow- joint (the first recorded instance of this
operation, says von Gurlt). The case was that of a common
soldier who had been shot through the forearm, a little
above the wrist, who had been treated unsuccessfully by
other surgeons, and who, at the time when he came under
Fare's care, was suffering from a variety of complica-
tions— viz., gangrene extending as high up as the shoulders,
extensive inflammation of the integuments on the adjacent
side of the thorax, and other symptoms that pointed toward
a fatal issue. To complicate matters, it was winter and
the only approximately warm shelter available was a cow-
stable. At this early date, in the history of surgery, the
practice of ligating the blood-vessels which had been divided
in the course of an amputation had not yet been adopted,
and consequently the red-hot cautery had to be employed
for arresting the bleeding which followed the operation.
(See also page 512.) In addition to the amputation it was
found necessary to make a number of long and deep
incisions into the inflamed tissues and to apply the actual
cautery freely *'for the purpose of drying up and destroy-
ing the virulent matters that had penetrated these parts. ' '
Then, fourteen days later, the patient, who had been lying
all this time, exposed to draughts of air, upon a receptacle
intended for the storage of grain, and who was protected
from the cold by only the scantiest coverings, developed
trismus (lockjaw). When this new complication appeared
Pare, already at his wits' end to find means with which to
overcome the difficulties which surrounded the case, decided
first to have the man removed to an adjacent stall in which
there were several cows, the presence of which in such a
confined space might be counted upon to increase appro-

DEVELOPMENT OF SURGERY IN FRANCE 509

ciably the warmth of the surrounding air. Next, he gave
orders to rub briskly the back of the patient *s neck, as well
as the shoulders, the uninjured arm and the legs, with
heated cloths which were immediately afterward to be
wrapped around him; and then, for an outside covering,
he utilized the straw and cows ' dung which were plentifully
within reach. In addition, two braziers which had been
procured from a neighboring dwelling, were charged with
coals and kept burning close to him. During three suc-
cessive days and nights these measures were kept up
faithfully, and from time to time a mixture of milk and
soft egg was introduced into the patient's mouth through a
suitable tube, after the jaws had first been pried open by a
bit of willow wood. The effect of these measures was to
make the patient perspire copiously and to induce a gentle
action of the bowels ; and, as a further effect, the trismus
was also overcome. For some time afterward, in addition
to the ordinary dressing of the healing wounds, it was
thought best to apply the red-hot cautery regularly at
certain intervals to the end of the bone of the upper arm.
(This practice was abandoned by Pare at a later date.)
Final and perfect healing took place after several large
splinters of bone had been exfoliated.

At the end of his account of what one is tempted to call
the wonderful victory of a surgeon over the death that
threatened to carry off this gravely wounded soldier. Pare
adds one of his characteristic appeals to the oncoming
younger generation of physicians : —

Both God and Nature constantly remind the surgeon that, no
matter how poor, in a given ease, the prospect of a cure may seem,
he should not for one moment cease doing his full duty ; for Nature
often accomplishes what the surgeon believes to be impossible.
Cornelius Celsus [about the time of Jesus Christ] says: ''Contin-
gunt in morbis monstra, sicut et in natura." [Marvels are observed
in diseases, very much in the same manner as they are frequently
encountered in nature.]

In the two preceding histories of actual cases treated, —
one of these patients being a wealthy officer of high rank
and birth, and the other a common soldier of the peasant

510 GROWTH OF MEDICINE

class, — we obtain the best of evidence that Pare was not
influenced by the wealth, rank or social position of his
patients. Upon both classes he bestowed freely the fruits
of his knowledge, experience and skill.

The first mention, in medical literature, of a fracture
through the neck of the femur close to the joint, is to be
found in Chapter 21, Book XIIL, of Fare's treatise (page
753, Vol. II., of Malgaigne's edition). Furthermore, the
first published account of a case of diaphragmatic hernia
is that given by Pare. (Von Gurlt.)

In 1538, during a visit to Turin in the capacity of surgeon
to the Mareschal de Montjean, Pare was asked by the latter
to take charge of one of his pages who had been wounded
by a stone which struck him on the right side of the head,
causing a fracture of the parietal bone, with escape of a
portion of the brain substance from the external wound.
The subsequent history of this case is given by Pare in the
following words : —

As soon as I fully realized the true nature of the injury and had
examined the mass of tissue (about the size of a small nut) which
had been expelled from the wound, I predicted that the patient
would probably not recover. A young surgeon who happened to
come into the room at this moment, examined the mass of tissue
which had escaped from the wound and at once pronounced it to
be fat. I assured him that, if he would wait until I had finished
dressing the patient's wound, I would prove to him that the mass
was in reality cerebral tissue and not fat If this sub-
stance, I said, is fat, it will float on the water; but, if it is brain
tissue, it will sink at once to the bottom of the dish. And, again,
if it is fat it will promptly melt on exposure to heat, whereas brain
substance will simply become desiccated. These tests were applied
and it was shown that the tissue consisted, as I had declared, of
brain substance.

Notwithstanding the apparently serious damage which had. been
inflicted upon his brain the page made a good recovery, but re-
mained permanently deaf in the right ear.

Among Pare's numerous reports of cases there is one
which possesses, as I believe, sufficient interest — as well
from the viewpoint of the pathologist as from that of the

DEVELOPMENT OF SURGERY IN FRANCE 511

surgeon — to justify me in reproducing it, in a somewhat
condensed form, in the present chapter.

Henry the Second, King of France, while tilting (June
30, 1559) with Gabriel, Count of Montgomery, an officer of
that sovereign 's Scottish Lifeguard, received injuries which
soon afterward proved fatal. Montgomery's lance — so
Fare's account states — struck the King's vizor and, break-
ing off at the spot where the metal tip or head is attached
to the wooden shaft, carried away this part of the helmet.
Then, impelled by the force which had originally been
communicated to the lance, the splintered end of its shaft
struck the King 's now unprotected head with great violence
just above the right eyebrow, tore up the skin and under-
lying muscular tissue of the forehead as far as the outer
angle of the left orbit, and finally destroyed the adjacent
eye. Five or six of the most experienced surgeons of
France were immediately summoned, and Philip the Second,
King of Spain, sent Vesalius from Brussels to aid them in
their efforts to save the injured King's life. But all the
measures adopted proved of no avail. Henry the Second
died on the eleventh day following the injury. Although
in the published account no statement is made to the effect
that Pare was one of the surgeons who attended the King
during his illness, Malgaigne expresses the opinion that he
was probably present in the capacity of a consultant ; and
the interesting comments which he (Pare) makes on the
nature and extent of the injury inflicted certainly justify
this opinion. No evidence of fracture of the skull was
discovered either before death or at the postmortem
examination, and the most conspicuous symptoms appear
to have been fever and a comatose condition. At the
autopsy there was found, on the left side posteriorly, in the
occipital region, a clot of blood lying between the pia and
the dura mater. The brain substance in the immediate
vicinity of the clot was of a yellowish tinge and showed
evidences of having already begun to undergo decomposi-
tion. Fare's diagnosis, in this case, was that of violent
concussion of the brain with rupture of meningeal vessels
by contre-coup at a point opposite to that at which the blow

/

512

GROWTH OF MEDICINE

was originally inflicted by the lance. He did not believe
that the immediate damage done to the frontal portion of
the cranium and to the left eye had anything to do with
the fatal issue.

One of the greatest discoveries made by Pare in the do-
main of surgery is his method of promptly, effectively and

safely arresting the bleeding from
the divided vessels of the stump
after the amputation of a limb.
This discovery was made between
the years 1552 and 1564, before
which period it had been customary
to arrest the bleeding by applying
the red-hot cautery iron to the ex-
posed ends of the divided vessels.
The new method consisted in tying
a ligature (preferably doubled)
around the free or cut end of the
blood-vessel, and allowing it to
remain undisturbed in situ until,
as the result of a localized suppura-
tion, it should be cast off. The
accompanying cuts (Figs. 23 and
24) which have been copied from
an earlier edition (1585) of Fare's
work, represent the kind of forceps
which he employed in separating
the free end of the artery or vein
from the soft tissues in which it
was imbedded — a preliminary pro-
cedure which enabled him to tie the
ligature firmly around the vessel.
The earlier pattern of forceps (Fig. 23) was not equipped
with a spring, the purpose of which was to keep the oppos-
ing blades separated, but the later pattern (Fig. 24) has this
useful addition. Another instrument which owes its origin
to the inventive genius of Pare is the grooved director — an
instrument that is of great value to the surgeon, particu-
larly in operations for the relief of strangulated hernia.

FIGS. 23 AND 24.

FORCEPS DEVISED IN 1552
BY AMBROISE PARE FOR
DRAWING OUT THE CUT
ENDS OF ARTERIES AFTER
THE AMPUTATION OF A
LIMB, AND HOLDING THEM
WHILE THE LIGATURE IS
BEING APPLIED.

(Prom von Gurlt's Geschichte der
Chirurgie, Berlin, 1898.)

Fig. 23 represents the earlier;
Fig. 24 the later pattern (see
text.)

DEVELOPMENT OF SURGERY IN FRANCE 513

Besides the two inventions to which a brief reference has
just been made, Pare describes and pictures in his great
treatise scores of instruments and apparatus of all sorts,
many of them doubtless products of his own inventive
genius. But to assign to these contrivances their true value
calls for a degree of expert knowledge which I do not
possess. Rather than to attempt any such appraisal, I
prefer to furnish here a summary of the more important
of Fare's achievements in surgery; for such an enumera-
tion— although it may prove to be in some measure a
recapitulation of things that have already been mentioned
in the preceding account — ^may be found useful for purposes
of reference: —

The discovery of improved methods of caring for the wounded
on the battle-field and of transporting them to a hospital or other
refuge; the introduction of better methods of treating wounds
inflicted in warfare — especially gunshot wounds; the correction of
the idea, universally accepted at the beginning of the sixteenth
century, that bullets are sufficiently hot, upon penetration of the
skin, to affect injuriously the wounds which they inflict ;^ the sub-
stitution of ligation of bleeding vessels (of an amputation stump)
for the prevailing practice of applying to them the red-hot cautery
iron; the abandonment of the practice of applying the heated
cautery iron to the surface of section of a sawed bone; the per-
formance, for the first time, of exarticulation of the elbow-joint;
the demonstration of the usefulness of more frequently employing
orthopaedic apparatus and prosthetic contrivances; and the intro-
duction of improvements in the operation of trephining the skull.

It was a very common practice among the medical authors
of the sixteenth century — and, indeed, among authors
generally — to utilize the writings of their predecessors
without giving them proper Qredit for their work; and
Pare, it appears, was not entirely free from this fault,
von Gurlt mentions a few of the more glaring instances
of such sinning, and among them the following: Pare's
two chapters on tumors are taken from the '*Z)e institutione

1 The fact that bullets are not hot when they inflict a wound was proven
experimentally by Bartolommeo Maggi several years earlier, but Par6 makes
no reference to this fact.

514 GROWTH OF MEDICINE

chirurgica^' of Jean Tagault (Paris, 1543), who in turn is
charged with having borrowed the data from Guy de
Chauliac's treatise; in his chapter on wounds in general,
Pare has also borrowed largely from the same work; and
the chapter which he devotes to the subject of special
wounds is taken from the writings of Hippocrates; and,
finally, he has transferred almost bodily Philippe de Fles-
selle's ^^Introduction pour parvenir a la vraie cognoissance
de la chirurgie rationelle.^' Before we condemn Pare for
plagiarism, and although the facts as stated by von Gurlt
are undeniable, we should take several things into careful
consideration. It is fitting, for example, that we should
make some sort of an estimate of the value of the text thus
appropriated, in order that we may be able to measure the
seriousness of Pare's sinning; and, if we do this, we cannot
fail to be struck with its insignificance in comparison with
the admittedly valuable character of all the remaining text
of these three huge volumes — text which bears every mark
of being the product of Pare's brain. Pare himself, in
speaking of his borrowings from other authors, says that
his acts of this nature are ''as harmless as the lighting of
one candle from the flame of another. ' ' Then, again, there
are several of these borrowings w^hich are evidently the
handiwork of a rather dull person, and this fact alone makes
one bold to assert that Pare, who was certainly not lacking
in brains or in a desire to follow the golden rule in his
treatment of the property of such writers, could scarcely
have been guilty of such clumsily contrived interpolations.
Inasmuch, however, as many important facts bearing upon
the question at issue are not within my reach, I am obliged,
in my attempt to defend the memory of Pare, to fall back
upon speculative reasoning. The medical profession at
large has long since heard this charge of plagiarism
and it refuses to attach any importance to it as affecting
the personal character of Pare. It prefers to believe
that he is guiltless and that somebody else — at a time,
perhaps, when Pare, being well advanced in years, was
too ill to revise the manuscript of the ''Collection of his
Writings" edited by Guillemeau — thoughtlessly yielded to

gzt- ^"^ — Premier Clunirgien Jc HeNRY JI.cU Fl<AN(^OJb

IJ. df Cha kles IX. etdc Henr yJII ^ L' 1 | | I

tilllllirillttBttMllllJlliilOllllllttMIhi.ih

FIG. 25. AMBROISE PARE, THE FAMOUS FRENCH SURGEON
OF THE SIXTEENTH CENTURY.

(From von Gurlt's reproduction of the portrait published by Le Paul-
mier, Paris, 1885.)

DEVELOPMENT OF SURGERY IN FRANCE 515

the impulse to remedy, by borrowing from other sources,
the trivial defects or omissions noted in the text. In any
case, whatever the actual truth may be, I am, I believe,
justified in maintaining that Pare is not rightly chargeable
with the guilt of plagiarism.

Strange as it might appear, if history did not furnish
many examples of the same character. Fare's merits as a
man and as a surgeon were not as fully appreciated as they
deserved to be until after the lapse of nearly two centuries.
In 1812 the Societe de Medecine de Bordeaux offered a prize
for the best eulogy of Ambroise Pare, and it was awarded
to Vimont. Finally, in 1840, a fine bust of the distinguished
surgeon was completed by the sculptor David of Angers,
and set up in bronze in Laval, Pare 's birthplace. The por-
trait here reproduced from the engraving in von Gurlt's
work represents the bust in question (Fig. 25).

A complete collection of the writings of Pare has been
prepared by J. F. Malgaigne, the distinguished French
surgeon, and published in three very large volumes (Paris,
1840-1841). This collection is based on a careful compari-
son and collation of all the previously published editions.
The contents of these volumes cover very nearly the entire
range of surgery.

CHAPTER XLI

SURGERY IN GREAT BRITAIN DURING THE SIX-
TEENTH AND SEVENTEENTH CENTURIES

In Great Britain the cultivation of the science of medi-
cine began at a much later date than it did on the continent
of Europe, and, so far as may be judged from the facts
within our reach, there were, in the early part of the six-
teenth century, very few Englishmen who could justly lay
claim to the possession of more than the rudiments of the
art of surgery. Two centuries earlier, as I have already
stated in a previous chapter, there were three men in Eng-
land who gained considerable fame in this department of
medicine. They were Gilbert **the Englishman" (1210),
John of Gaddesden (1320), the author of the famous book
entitled **Rosa Anglica," and John of Ardem {circa 1350) ;
but afterward, for a period of nearly two hundred years,
the records fail to reveal to us a single surgeon of any note.
Then during the sixteenth century the only English sur-
geons whose names deserve to be perpetuated are Gale,
Clowes and Woodall, of whom I shall presently give brief
accounts. They were all at one time or another, as in the
case of the leading continental surgeons of that period,
officially connected with the army. Some idea of the unsat-
isfactory state of the medical service in the English army
of that period may be gathered from the statements made
by Gale regarding this matter. From his account it appears
that in 1544 the army was accompanied by a miscellaneous
crowd of men who were supposed to be in some measure
physicians, but who in reality were uneducated quacks,
vendors of all sorts of dressings and washes for wounds,
of infallible cures for gunshot injuries, etc. The mortality

EARLY SURGERY IN GREAT BRITAIN 517

in the English camp was, as might readily be expected, very-
heavy. The same state of things existed, at a somewhat
later date, in the fleet sent against the Spanish Armada.
It is not to be wondered at, therefore, that very few of the
educated surgeons were willing to accept service in the
English army or the English fleet, especially as the pay
which they received was no greater than that of the
drummers and trumpeters. Toward the end of the century
much greater attention was paid to the care of the wounded
and crippled, and, in corroboration of this, it may be stated
that Henry the Fourth, King of France, — who, it may
safely be assumed, was influenced to take this step by the
enlightened advice of Ambroise Pare, — ordered the estab-
lishment of military hospitals for the use of the army which
was at that time besieging Amiens. And again, at a later
date (1603), there was established at Paris a retreat for
old and infirm or mutilated officers and soldiers.

It is an interesting fact that during the year 1544, while
Henry the Eighth of England, in alliance with the German
Emperor Charles the Fifth, was carrying on the war
against Francis the First, King of France, there were
present, on the soil of the latter country, all the leading
European surgeons of that period — viz., Ambroise Pare,
with the French army which was laying siege to Boulogne-
sur-Mer (captured a few months earlier by the English
troops) ; Thomas Gale, the most famous surgeon of that
day in England, with the army of the besieged; and
Vesalius and Daza Chacon with the troops of Charles the
Fifth at Landrecy (near the Belgian boundary, south of
Brussels) and at St. Didier (in the northeastern part of
France). I have already, in -preceding chapters, given
brief accounts of the lives and professional accomplish-
ments of all these surgeons with the exception of Gale, and
it only remains now to supply such information as may be
obtainable concerning the latter and also concerning his
contemporaries, the English surgeons Clowes and Woodall.

Thomas Gale. — Thomas Gale was born in London in 1507,
practiced medicine for some years in that city, and then,
in the capacity of a surgeon, entered the service of the army

518 GROWTH OF MEDICINE

under Henry the Eighth. At a later date he joined the
army of Philip the Second of Spain. In 1544 he was present
at the battle of Montreuil in France, and he was also
present at the siege of St. Quentin, in 1557. Two years
later he returned to London and became a member of the
Barber-Surgeons' Company. His death occurred in 1587.
Gale was the author of several books on surgical subjects,
the most important of these works being that which deals
with gunshot wounds. His views regarding wounds of this
nature agree in the main with the teachings of Ambroise
Pare; and yet, according to von Gurlt, he appears to have
formed his opinions independently, for he does not once
mention that surgeon's name. He was not only a skilful
surgeon, but also a man of scientific and literary tastes^
as shown by his translations of some of Galen's writings
and of Giovanni da Vigo's treatise on surgery, and also
by his own published works. His book on gunshot wounds,
to which reference has already been made, is the one which
reflects the greatest credit upon the author. One of its
chief merits is to be found in the fact that it enabled the
physicians of England to keep in some measure abreast of
their brethren on the continent, at least in the matter of
treatment by surgical means. In one part of the work he
makes reference to the belief, which was held at that time
by many surgeons, that the bullet not only scorched the
flesh of the wound which it inflicted but also introduced
into it a poisonous element. I quote here one or two extracts
from the comments to which I have just referred : —

The usnall Gonnepowder is not venemous, nother the shotte of
such hoteness as is able to warme the fleshe, much lesse to make an

ascar Hange a bagge ful of Gonnepouder on a place

convenient : and then stand so far of as your peece wil shote leavell,
and shute at the same, and you shall see the Gonnepouder to bee
no more set on fyer with the heat of the stone [used as a bullet]
than if you caste a cold stone at it.

An English translation of Pare's book, says von Haller,
was not published until 1577. It is therefore not strange
that Gale, whose book was printed fourteen years earlier

EARLY SURGERY IN GREAT BRITAIN 519

{i.e., in 1563), should have made no mention of that author's
method of applying ligatures to the bleeding vessels of an
amputation stump. The first reference (in English) to this
plan of preventing hemorrhage from the divided blood-
vessels in an amputation stump occurs — so far as I have
been able to discover — in the treatise published in London
by William Clowes, in 1588, under the title *'A prooved
practise for all young chirurgians etc." Clowes, however,
erroneously gives the credit for this important procedure
to Guillemeau, one of Pare 's pupils.

In one of his writings Gale states, after witnessing the
surgical practice at the Royal hospitals of St. Bartholomew
and St. Thomas in 1562, ' ' that it was saide that Carpinters,
women, weuvers, coblers and tinkers did cure more people
than the chirurgians." (South.)

William Clowes. — "William Clowes was born, about the
year 1540, at Kingsbury, in Warwickshire, and received his
early training in surgery under George Keble of London.
In 1563 he accepted the position of surgeon in the army
which was under the command of Earl Ambrose of War-
wick and was stationed at that time in France. Six years
later he settled in London, and was made a member of the
Barber-Surgeons' Company. In 1575 he received an
appointment on the Surgical Staff of St. Bartholomew's
Hospital and six years later still he was promoted to the
rank of full surgeon, a position which he already held in
Christ's Hospital. In 1585 he resigned his appointment
at St. Bartholomew's and accepted an invitation to serve
in the Earl of Leicester's army, which was at that time in
the Netherlands. During this war Clowes acquired a rich
and varied experience in the treatment of wounds. Soon
after his return to London in 1588 he joined the fleet which
vanquished the Spanish Armada. Later, he was given the
appointment of Surgeon to the Queen. His death took
place at Plaistow, County of Essex, in August, 1604. Von
Gurlt does not hesitate to qualify him as one of the most
distinguished English surgeons of his day.

Of the four surgical treatises which were written by
Clowes, and of which several editions were published

520 GROWTH OF MEDICINE

between the years 1575 and 1637, there is only one to which
I shall refer in this brief account, viz., that which, in the
edition of 1637, bears the title : ^' A profitable and necessarie
Book of Observations, for all those that are burned with
the flame of Gun-Powder." This book is full of brief his-
tories of cases which came under the author's personal
observation, and it therefore furnishes an excellent and
truthful picture of the kind of wounds which the highway-
men and soldiers of that day inflicted, and of the treatment
which was employed by the best English surgeons. The
following may serve as sufficient examples: —

(1) A clothier, who had been assailed by robbers, received
a dangerous wound in the left thigh. It was about four
inches long and of such a depth that **the rotula or round
bone of the knee did hang downe very much. ' ' Clowes first
removed a clot of blood from the wound and then, ''with
a sharp and square-pointed needle, armed with a strong,
even and smooth silke thred, well waxed, introduced five
stitches, one good inch distant betweene every stitch,
leaving a decent place for the wound to purge at." He
then applied a suitable bandage. The patient's friends
were not at all pleased that Clowes, having pronounced the
wound dangerous, should not have been willing to state
how much time would elapse before it would be healed. So
they called in a charlatan, who on the following day
removed the dressings and cut through all the stitches.
Seven days later, Clowes was once more asked to see the
case. He found the wound gaping widely and in a bad
state. After adopting such measures as were most
urgently required, he brought the edges of the wound
together by the application of three strips of sticking-
plaster. In due time healing took place, ''but the motion
perished: for the patient had the imperfection of a stiff
knee, which constrained him to use a leather strap, fastened
unto the toe of his shooe, and again made fast unto his
body ; and so he remaineth unto this day. ' '

(2) The history of the second case may be given here
in the following brief outlines. The patient, a ship's
gunner, was wounded in the lower part of the abdomen by

EARLY SURGERY IN GREAT BRITAIN 521

what was probably a partially spent ball. The wound made
by the missile was of such a nature that it permitted a large
portion of the "zirbus" (omentum), together with some
of the intestinal canal, to protrude from the opening. After
making a careful examination of the parts, Clowes was
satisfied that the intestine was still uninjured.

Then with a strong double thread I did tie fast the zirbus as
close unto the wound as possible wel I might, and within a finger
bredth or thereabouts I did cut off that part of the zirb that hanged
out of the wound, and so I cauterized it with a hot iron almost to
the knot ; all this being done, I put again into the body that part of
the zirb which I had fast tied, and I left the peece of thred hanging
out of the wound : which, within four or five days after, nature cast
forth, the thred as I say being fast tied; then presently I did take
a needle with a double strong silke thred waxed, wherewith I
did thrust Ahorow both mirach [skin, adipose layer and muscular
tissue] and ziphach [peritoneum] on the right side of the wound,
but on the left side of the wound I did put the needle but thorow
mirach only, and so tied these three fast together with a very strong

knot, and presently I did cut of the thred All which is

according to Weckers^ and other learned men's opinions and prac-
tices, who also say that the stitches of the one side must be higher
than on the other side. [The usual dressings were afterward
applied and were renewed three days later. At the end of twenty-
one days the wound was found to be completely healed.]

In chapter 27 of the same work there is given a list of
the medicaments and instruments with which a field- or
ship 's-surgeon should be equipped before he engages in
active service. From this list I select the following items
as showing — at least in some measure — in what respect the
tools employed by surgeons four hundred years ago differ
from the modern ones of a similar character : ' ' Small and
long waxe candles to search the hollownesse or depth of a
wound. " ' * Small buttons or cauterizing irons meete to stay
the flux of an artery or veine." *'A trepan." ''Needles
two or three, some eight inches, some ten or twelve inches
in length, having a decent eye in it guttered like a Spanish

1 Johann Jacob Wecker (1528-1586), born at Basel, Switzerland, and author
of a treatise entitled "Practica medicinae generalis" (Basel, 1585).

522 GROWTH OF MEDICINE

needle, and point or end blunt or round, that it offend not
in the going in of it, made fit to draw a Flammula, or a
pece of fine lawne or linnen cloth through the body or
member that is wounded." *'As for stitching quils and
other instruments, that a Surgeon ought always to carry
about him, I leave unspoken of."

In praise of one of the plasters enumerated in the list,
Clowes narrates the following incident which occurred near
Arnheim in the Netherlands: *'A horseman was wounded
with a pike neere the middle of his right thigh ; the weapon
so passing upwards that by good fortune it rested upon
the OS pubis, otherwise he had been slaine." As the first
step in the treatment, the copious bleeding was arrested;
after which warm oleum hyperici [oil of St. John's wort]
was injected into the wound, then a short tent was intro-
duced, and the sticking plaster was applied on the outside.
''Thus he was cured in fourteene days, and so was ready
to serve in the field again. ' '

John Woodall. — John Woodall or Woodhall was born in
England about 1569, and was sent as a military surgeon
to France by Queen Elizabeth with the troops which Her
Majesty placed at the disposal of the French King, Henry
the Fourth. After his return to England, Woodall was
made a surgeon of St. Bartholomew's Hospital and also
Surgeon-General of the East India Company. He was
already at that time a member of the Company of Barber-
Surgeons of London. Woodall must have had a very
extensive experience in the practice of surgery, for he
states that he had performed the operation of amputation
of a limb more than one hundred times. The date of his
death is not known.

Von Gurlt calls attention to the fact that the first notice
printed in English of Ambroise Fare's method of ligating
blood-vessels after an amputation is to be found in the
treatise written by John Woodall and published in London
in 1639, under the title: ''The Surgeon's Mate, or Military
and Domestic Surgery." As the first edition of this book,
which was published in 1617, says nothing about Fare's
method, it seems permissible to infer that the news of this

EARLY SURGERY IN GREAT BRITAIN 5^3

improvement, one of the most important made in surgery
(1552), reached England from France only after the lapse
of eighty-seven years! There can be scarcely any donbt,
however, that individual English surgeons had already
learned about Fare's improved method at a much earlier
date.

State of Surgery in England During the Seventeenth
Century. — Before I pass on to the consideration of the state
of surgery in England during the seventeenth century it
seems desirable that I should say a few words with regard
to the relative standing of the two branches of the medical
profession — the physicians and the surgeons — in the es-
teem of their fellow Englishmen at this period of history.
In France, it will be remembered, a surgeon was looked
upon, even as recently as during the first half of the six-
teenth century, as a man of inferior social standing, perhaps
a shade better than an apothecary, but certainly far below
his more highly educated associate — the physician. The
favors extended by French Royalty to Ambroise Pare and
the Very high esteem in which he was held by French society
in general effected a great change in the relative status of
the two classes of practitioners in France ; and, as a result
of this change in public opinion, medical practitioners,
subsequent to 1560 or 1570, were led to realize that a
surgeon, if sufficiently educated, if earnestly devoted to his
professional work, and if intent upon helping his fellow
men rather than upon accumulating a fortune, might con-
fidently aspire to a position of equality with the best physi-
cians of the community in which he lived. In England a
similar change of opinion in regard to the honorableness
of the career of surgeon took place about this time, probably
in consequence of the great reputation gained by Gale,
Clowes and Woodall. In both countries the change occurred
slowly, and in France what was gained during Fare's life-
time seemed afterward to be lost for a period of several
years. But eventually the prevailing opinion again became
favorable to the surgeons, and from that time to the present
they have enjoyed an ever-increasing esteem in public
opinion. But there was a brief period, early in the seven-

524 GROWTH OF MEDICINE

teenth century, when it must have been very galling to the
pride of an honorable and experienced surgeon to be placed
as it were under the tutelage of the physicians who were
his official associates in certain hospitals — as, for example,
in St. Bartholomew's, London. The following extracts^
from the *' Orders" or ''Articles" of that institution (1633)
explain more precisely what is meant by the use of the
word ' ' tutelage " : —

9. That no surgeon or his man do trepan the head, pierce the
body, dismember or do any great operation on the body of any but
with the approbation and by the direction of the Doctor (when
conveniently it may be had) and the surgeons shall think it needful
to require.

13. That every surgeon shall follow the directions of the Doctor
in outward operations for inward causes, for recovery of every
patient under their several cures, and to this end shall once in the
week attend the Doctor, at the set hour he sitteth to give directions
for the poor.

(From St. Bartholomew's Hospital Reports, Vol. XXII., 1886.)

Among the English surgeons of the seventeenth century
there appears to have been only one who attained some
degree of eminence, viz., Richard Wiseman, who is often
spoken of as the Ambroise Pare of England. Haeser men-
tions 1625 as the date of his birth, and at the same time
states that he was in the service of the Stuart Kings from
Charles the First to James the Second. It seems to me
highly probable that this statement regarding the date of
Wiseman's birth is erroneous; for if it be accepted as
correct, then he (Wiseman) must have been only fifteen
years of age when he first started out with the prince (in
1640) on the latter 's wanderings through Prance and the
Low Countries. On the other hand, if Wiseman was really
jborn in 1625, then we shall be justified in assuming that
he traveled with the prince at first simply as his companion
and not in a professional capacity; and we shall be further
justified in assuming that he acquired his medical and
surgical training during his residence on the continent.

2 In this instance I have thought it best to modernize the spelling of several
of the words.

EARLY SURGERY IN GREAT BRITAIN 525

In 1650 Wiseman returned with the prince to Scotland.
At the battle of Worcester he was taken prisoner by the
Parliamentary army under Cromwell and did not regain
his liberty until 1652, at which time he settled permanently
in London. After the Restoration in 1660, his practice
increased very greatly and, so far as one may judge from
the large number of cases which he reports in his work on
surgery that was first published in 1676, it must have been
very extensive and of a most varied character. I have read
many of these reports of cases that occurred in Wiseman's
practice, and have been much impressed with the thor-
oughly practical character of the treatment which he
adopted in the majority of instances, and also with the
very clear and concise manner in which he narrates the
attendant circumstances — the nature of the malady or of
the injuries received, the treatment which he adopted, and
the final results attained. In the belief that they may
furnish corroborative evidence of the statements which I
have just made, I now take the liberty of reproducing here
two of these reports of cases : —

(1) Whilst I was a prisoner at Chester (1651), after the battel
of Worcester, I was carried by Colonel Duckinfield's order to a
man that out of much zeal to the Cause, pursuing our scattered
forces, was shot through the joint of the elbow ; the bullet entering
in at the external part of the os humeri, and passing out between
the ulna and radius. He had been afflicted with great pain the
space of six weeks. I found the wound undigested,^ and full of a
loose, soft, white flesh, the bones fractured, and not likely to unite,
many shivers lying included within the joints, and incapable of
being drawn out. The lower part, of the arm was oedematous to
the fingers' ends as full as the skin could well contain, and the
upper part was inflamed; also about the os humeri and axilla a
perfect phlegmon was formed. The patient thus tired with pain,
desired to be cured or have his arm cut off. To which purpose he
had procured the Governor's leave for my staying with him. But,
while that phlegmon was upon the upper parts, there was no hope
of a prosperous amputation, nor of cure while those shivers of
bone lay pricking the nervous parts within the joint. The phlegmon

8 Not healing in a healthy manner.

526 GROWTH OF MEDICINE

was too forward for repercussion,* and yet not likely to suppurate
in less than a week's time. Wherefore I endeavored by emollients
and some discutients to succour the grieved shoulder and parts
thereabout by hindering the increase of the phlegmon, and to give
some perspiration to the part. Then with good fomentations I
corroborated the weak and oedematous member below; in which
end I also raised his hand nearer to his breast. Also by detergents
and bandage I disposed the wounds and fractured part to a better
condition, made way for discharge of matter, and endeavored to
extract the shivers of bones; then applied medicaments to remove
the caries. After some days the abscess suppurated in the upper
part of the shoulder and in the armpit; and while the matter
discharged from thence, the tumour discussed, and that upper
orifice cured soon after. But the continual pain in the fractured
joint kept that opening in the axilla from healing. The patient
growing weaker, and without hopes of cure, I was necessitated to
proceed to amputation. To which purpose I sent to Chester to
Mr. Murry, a knowing chirurgeon (since Mayor of that city), to
come with instruments and other necessaries, whereby I might the
better do the work. He accordingly came, and we prepared dress-
ings ready; which were stupes or pledgits of fine short tow well
worked, some like splenia [bandages], others were round, and bigger
or less. We wetted them all in oxy crate [water and vinegar] , and

dried them; et cetera

The apparatus thus made, and the patient some while before
refreshed with a good draught of caudle [a hot drink made of
spiced and sugared wine], his friends took him out of his bed, and
placed him in a chair toward the light. One of his servants held
his arm; another of his friends held his other hand. Then Mr.
Murry drew up the skin and musculous flesh of the arm towards
the shoulder, whilst I made a strong bandage, some three or four
fingers' breadth, above the affected part. Then with a good knife
I cut off the flesh by a quick turn of my hand, Mr. M. pulling up
the flesh, whilst I bared the bones.^ After which, with as few
motions of my saw [as possible] , I separated the bone [s] , the patient
not so much as whimpering the while. After this Mr. Murry
thrusting his hands downwards with the musculous flesh and skin
which he had drawn upwards, I passed a strong needle and thread
through the middle of the flesh and skin on both sides, within half

4 Driving back.

5 Haeser speaks of Wiseman as having gained considerable distinction by
the careful manner in which he made provision for the flaps in his amputations.

EARLY SURGERY IN GREAT BRITAIN 527

an inch of the edges, and brought the lips close within a narrow
compass ; and having tied that ligature fast, and cut off the string,
I passed the needle again through the two contrary sides, which I
tied as close; then loosened the ligature above, and applied the
little round stupes of tow spread with a quantity of Galen 's powder
mixed with egg albumen. The long pledgits were applied from
the middle of the stump each way upwards along the arm, over
which I put on a bladder and a cross cloth, then rowled up the
stump, and made the bandage [pass] under his other arm and over

his neck He being thus dressed up, we put him into his

bed. The third day we took off his dressings, and found the stump
well digested, and at least two spoonfuls of matter discharged.

During which the bone exfoliated, and the stump soon

after cicatrized. Then having procured a pass to come to London,
I hastened away.

(2) A lady coming to town with a swelling in her left breast,
consulted some of our Profession, and at last me. She said she
had some years since kernels in her breast, which were judged the
' ' King 's Evil ' ' ; upon consideration of which she was presented
to His Majesty, and touched. In progress of time they swelled,
and her breast being extremely painful, she desired my judgment
of it. The swelling was large and round, and greatly inflamed,
under which it was soft and seemed to have matter in it. The
parts more distant were hard, and several tubercles lying under
the skin made it unequal ; yet the breast was not fixed. She urged
me instantly to deliver my thoughts of it ; which to decline I turned
from her, and told her friend it was a cancer, and that I saw no
hopes to save her life but by cutting it off. He wished me to con-
sider how I delivered such judgment of it, two chirurgeons having
lately assured her the contrary, they taking it for a phlegmon.
But I, not being used to guide my judgment by what others deliv-
ered, confirmed to him what I had before said by a sad prediction,
which befel her in few weeks after. And indeed there was no way
then to deal with it but by cutting off her breast.

One is not a little startled, after reading a number of
case-histories like the two which I have just reproduced,
to discover other portions of text (Vol. I., pp. 384 and 385)
which show clearly that Wiseman, although a surgeon of
the most practical character and a man equipped with
excellent reasoning powers when he was placed in the
presence of most of the problems which are constantly

528 GROWTH OF MEDICINE

being submitted to physicians for solution, was neverthe-
less the victim of a belief that supernatural powers may-
reside in certain human beings. Speaking of the cure of
the ''King's Evil" — also called by him ''struma" and
"scrofula" — Wiseman, in the chapter which he devotes to
this subject, makes the following statement: —

But when upon trial he (the chirurgeon) shall find the con-
tumaciousness of the disease, which frequently deluded his best
care and industry, he will find reason of acknowledging the good-
ness of God; who hath dealt so bountifully with this Nation in
giving the Kings of it, at least from Edward the Confessor down-
wards (if not for a longer time), an extraordinary power in the

miraculous cure thereof I myself have been a frequent

eye-witness of many hundreds of cures performed by his Majesty's
touch alone, without any assistance of chirurgery ; and those, many
of them, such as had tired out the endeavors of able chirurgeons
before they came thither.

Some years before his death, which occurred in 1686,
Wiseman was given the title of Serjeant-Chirurgeon to
King Charles the Second.

CHAPTER XLII

REFORMS INSTITUTED BY THE ITALIAN SUR-
GEON MAGATI IN THE TREATMENT OF
WOUNDS.— FINAL ENDING OF THE FEUD
BETWEEN THE SURGEONS AND THE PHYSI-
CIANS OF PARIS.— REVIVAL OF INTEREST IN
THE SCIENCE OF OBSTETRICS

Reforms Instituted by Magati. — Cesare Magati, who was
born in 1579 at Scandiano, in the Duchy of Reggio, studied
medicine at the University of Bologna and received the
degree of Doctor of Medicine from that institution in 1597.
Immediately afterward he went to Rome and devoted him-
self particularly to the study of anatomy and surgery.
Then, upon his return to his native land, he quickly acquired
so great a reputation as a surgeon that the Duke of Benti-
voglio, who was a man of enlightened views and ambitious
to promote in every possible way the best interests of the
University of Ferrara, offered Magati the Chair of Surgery
in that institution. The offer was accepted in 1612, and
Magati continued to hold the position for several years,
his services being highly appreciated both by the authori-
ties of the university and by the students. But, when his
health began to break down, — he was affected with stone
in the bladder, — he decided that his best course was to
resign his professorship, retire from active practice, and
become a Capuchin monk. When he took this step he
obtained permission from the head of the Chapter to which
he belonged, to resume in a limited measure the surgical
work which he was so well fitted to do. But in the year
1647 his sufferings became so acute that he was obliged to

530 GROWTH OF MEDICINE

visit Bologna in the hope of obtaining relief through
operative interference. The operation, however, did not
prove successful, and death occurred shortly afterward.

Magati effected, in a quiet and unostentatious manner,
a number of desirable reforms in surgical procedures.
Thus, for example, he pointed out how undesirable it is, in
most cases, to change the dressings of a wound so frequently
as was, at that period, the common practice. The process
of cicatrization, he insisted, is not effected by the efforts
of the surgeon, but is fundamentally the work of Nature.
Then, in addition, he protested against the practice of
introducing wicks and pledgets of lint into wounds. These
criticisms and this advice, says von Gurlt, had been given
many times before by different ancient authors, but they
undoubtedly had to be repeated from time to time.

The treatise in which Magati has written these things
bears the following title : ''De rara medicatione vulnerum,
seu de vulnerihus raro tractandis, libri duo," Venice, 1616
and 1676; also Nuremberg, 1733.

Final Extinguishment of the Long-standing Feud between
the Surgeons and the Physicians in Paris. — At several
points in the course of this sketch of the history of medicine,
I have called attention to the fact that, during the centuries
preceding those which are reckoned by certain authors as
belonging to modern times, surgeons as a class were gener-
ally looked upon, especially in the larger cities of France,
as decidedly inferior to physicians. The first attempt at
something like systematic instruction in surgery was made
by the Brotherhood of Saint Cosmas and Saint Damian at
Paris. This organization, which was founded by Jean
Pitard about the middle of the thirteenth century, was
composed of a group of barbers who felt a strong desire to
secure for themselves a better training than was obtainable
by the generality of barbers in those days. The latter were
known as ''surgeons of the short gown," while the more
ambitious men, who belonged to the group mentioned above,
were known as "surgeons of the long gown." With the
progress of time this smaller group of barbers really suc-
ceeded in making better surgeons of themselves, but in

THE SAINT COME MEDICAL SCHOOL 531

accomplishing this they intensified at the same time the
jealousy which the physicians as a class felt toward them, a
jealousy which repeatedly manifested itself in the form of
downright persecution. The data for a complete account of
this persecution, that persisted through centuries, are lack-
ing, and even if I possessed them I should not care to devote
the time that would be required for a proper presentation
of the subject. It is pleasant, however, to be able to record
the fact that these plucky barbers never entirely lost
courage, but fought on, year after year, until they even-
tually succeeded — with the help of a strongly sympathetic
public — in making the St. Come Medical School the nursery
of some of the best surgeons in France during the sixteenth
and seventeenth centuries. It was here, for example, that
Pare, Guillemeau, Thierry de Hery and other men of dis-
tinction obtained their early training, and it was doubtless
through their influence- that some of the wealthy patients
whom they had treated successfully, were induced to con-
tribute liberally to the support of the school. The final
event in the history of this institution was the complete
overthrow of the opposing physicians and the merging of
the two surgical schools — that of the regular Faculty and
the St. Come School — into one, under the direction of de
Lapeyronie, of whom I shall now furnish a brief sketch.

Frangois de Lapeyronie. — Frangois de Lapeyronie was
born at Montpellier on January 15, 1678, and he enjoyed
the privilege of receiving a most careful preliminary
education. He was only seventeen years of age when the
academic degree which corresponds to our Master of Arts
was bestowed upon him. As the next step he visited Paris
for the purpose of perfecting his knowledge of surgery, the
branch of science in which he was specially interested ; and
upon his return to Montpellier he began giving instruction
in anatomy and surgery. In a short time he was chosen
Surgeon-in-Chief of the Montpellier Hotel-Dieu. In 1714
he was called to Paris to take charge of the Due de
Chaulnes, whose malady had not yielded to the treatment
adopted by the surgeons of that city; and in this case the
measures which he employed proved so efficacious that de

532 GROWTH OF MEDICINE

Lapeyronie decided to settle permanently in the metropolis.
He taught anatomy in the College de Saint-Come, and in a
short time was chosen Head Surgeon of the Charite, one
of the largest hospitals of Paris. In 1731 he became one
of the founders of the Royal Academy of Surgery, and he
took a most prominent part in the struggle which was then
actively going on between the physicians and surgeons of
Paris, — one of the last and most serious of the attempts
made by the former to render the surgeons subordinate
to the physicians. The surgeons won the battle (April 23,
1743), and Dezeimeris says that the part taken by de
Lapeyronie in this struggle may be looked upon as one of
the most honorable achievements recorded in the history
of medicine. De Lapeyronie died on April 25, 1747, after
a long and painful illness. In his will he made most liberal
provision for the promotion of medical science; establish-
ing funds for the giving of annual prizes, for the founding
of a medical library, for the building of an anatomical
amphitheatre, etc. In his treatise on anatomy Hyrtl, the
distinguished professor at the University of Vienna, makes
the following brief statement with reference to a certain
dissecting room in Paris, but he does not state in what part
of the city the room in question is located, nor does he
mention any other facts that might enable his readers to
fix its location. In the absence of more precise information
concerning this matter, I shall take the liberty of suggesting
that Hyrtl 's discovery was made in the Anatomical
Institute which de Lapeyronie founded. Hyrtl 's statement
reads as follows: —

Over the entrance doorway of a dissecting room in Paris I read
this inscription: Hie locus est ubi mors gaudet succurrere vitae.
[Here is the spot where Death rejoices to render assistance to Life.]
No more beautiful or fitting words could be employed for inspiring
the student, upon his first entrance into the room, with respect for
the work in which he is about to engage.

And yet, a few pages beyond that on which the above
statement is printed, Hyrtl quotes Vicq d'Azyr as saying:
** Among all the sciences anatomy is perhaps the one the

RENEWED INTEREST IN MIDWIFERY 533

usefulness of which has been most highly lauded, but at the
same time the one for which the least has been done to favor
its advancement."

The Revival of Interest in Obstetrics. — ^With Soranus,
the early Greek writer on obstetrics, this science seemed
to come to a standstill, and during all the intervening cen-
turies, up to the sixteenth, not a single work of any special
value was published on this subject; for it is safe to say
that nobody would claim for the one or two obstetrical
treatises that were written by teachers in the Medical
School of Salerno during the ninth or tenth century, that
they contributed materially to advance our knowledge in
regard to this branch of medicine. It therefore seems
fitting, as suggested by Haeser, that during the century
which gave birth to such immortal works as those of
Vesalius and Pare, there should appear somebody who
possessed the inclination to stir once more into life the
dying embers of the science of midwifery ; and such a man
was found in the person of Eucharius Roesslin, the elder,
more commonly known — says Dezeimeris — by the Greek
name of * * Rhodion. ' ' He lived during the first half of the
sixteenth century, his death occurring about the year 1526,
and his was the first modern treatise especially devoted to
obstetrics. He began the practice of medicine in the city
of Worms, in the central part of Germany, and then moved
to Frankfort-on-the-Main, where he filled the salaried oflSce
of City Physician. Midwifery, at that time, was left entirely
in the hands of ignorant old women; and it was only in
response to the wishes of Catherine, the Duchess of Bruns-
wick and Liineberg, that Rhodion undertook to prepare a
manual from which these ignorant and careless women
might learn to conduct their midwifery work in a more
efficient, safe and acceptable manner. This little treatise,
which was first published at Worms in 1513, passed through
a number of editions and was translated into Latin, French,
Dutch and English. Von Siebold says that Rhodion com-
piled its text from various ancient sources, and added
practically nothing from his own experience. The woodcuts.

534 GROWTH OF MEDICINE

which are supposed to represent the different positions of
the foetus in the uterus, are not at all in accordance with
the truth, and show the most marvelous products of the
artist's fancy. Von Siebold states, however, that the
prejudices which at that time existed in the minds of the
people against the slightest participation of males in
the operations of midwifery were so strong that Rhodion
would not have been permitted to do anything toward
learning the truth by the employment of direct observation
and careful examination — the only possible way in which
the actual facts might have been learned.

Rhodion 's book, notwithstanding the defects to which I
have just referred, accomplished much good. It also
restored the operation of podalic version to the position
which it deserved, and it improved the service of the mid-
wives, — which was what the Duchess chiefly desired, — and
it undoubtedly emphasized the fact that the time had
arrived when obstetrics should receive the same degree of
scientific study that was being bestowed on all the other
departments of medicine.

The title of Rhodion 's (or Roesslin's) little book reveals
the fact that he possessed no small degree of humor. It
reads: ''Garden of Roses for Pregnant Women and for
Midwives," Worms, 1513.

The Operation Known as Caesarian Section. — The fol-
lowing statements relating to the operation known as
*' Caesarian section" have been compiled from Haeser's
Geschichte der Medicin: — This operation, which owes its
name to the erroneous idea that Caesar was brought into
the world by its aid, is commonly believed to have been
practiced on different occasions throughout antiquity, but
there has not yet been found in the records of history any
account which shows clearly that the operation was per-
formed upon a living woman, and also that the incision
extended not merely through the abdominal integuments,
but also through the actual uterine wall. At Siegershausen,
in Switzerland, — according to the report of Caspar Bauhin
in the treatise {^^Gynaecia^^) which he published at Basel
in 1586, — a man named Jacob Nufer performed (about

RENEWED INTEREST IN MIDWIFERY 535

1500) what was believed to be a Caesarian section on his
own wife, and delivered a living child. Both mother and
child did well ; the child growing up to the age of seventy-
seven and the mother giving birth to living children, per
vias naturales, several times afterward. In this instance
it is generally believed that the case was one of abdominal
pregnancy and that the wall of the uterus had not been
incised.

The first separate treatise on Caesarian section was
written by Frangois Eousset, and in it are reported several
cases in which the operation was said to have been per-
formed successfully. But both von Siebold and Kurt
Sprengel do not seem willing to accept these reports as
genuine, and we are therefore compelled to assume that
the first trustworthy account of a Caesarian section suc-
cessfully performed by a Dr. Trautmann of Wittenberg (in
1610) is that given by Sennert in a communication which
was printed early in the seventeenth century.

Invention of the Obstetrical Forceps. — After the publi-
cation of Eoesslin's ''Garden of Roses," the book of which
I gave a brief sketch on a previous page, nothing worthy
of special note was done for a period of several years to
advance the existing knowledge of midwifery or even to
systematize that which had already accumulated. Then
there began to appear evidences of an awakening among
those physicians who recognized the importance of this
department of medical science, and as a result there were
soon placed upon record accounts of two or three advances
of real and permanent value. One of the first of these
gains, for example, was the revival and general acceptance
of the practice of podalic version, or version by internal
manipulations, — that is, the operation of changing the
faulty position of the foetus in utero in such a manner that
the feet shall be the parts which protrude into the vagina.
Podalic version — as it appears from the account given by
von Siebold — was known to the ancients, both Celsus and
Aetius having described it in their treatises, but it was
afterward forgotten or neglected until Ambroise Pare, in
1550, again recommended it in one of his writings. At the

536 GROWTH OF MEDICINE

same time Pare states, at the very beginning of his mono-
graph on this subject, that his colleagues, Thierry de Hery
and Nicole Lambert, had both of them already carried out
the method in certain cases. This fact, however, does not
detract from the credit due Pare for having been the first,
after the lapse of several centuries, to bring the operation
to the knowledge of the medical profession ; and from that
day to the present it has held a fixed place in the" science
of obstetrics. As will be readily understood, this is not the
proper place in which to furnish details with regard to the
operation itself. When Pare was asked whether it would
be permissible for the midwives to undertake this operation
of podalic version, he replied that it would be, provided the
individual who assumed this responsibility felt convinced
that she possessed the requisite degree of skill and expe-
rience in work of this nature, and provided also that — as
soon as she began to suspect her inability to finish the
operation successfully — she would promptly call to her aid
a skilful surgeon, one who had acquired considerable
experience in obstetrical operations. Pare's favorite pupil,
Jacques Guillemeau (1550-1630), a native of Orleans,
France, made several important additions to our knowl-
edge of the operation of podalic version, and he was also
in other respects an important promoter of the science of
operative obstetrics. His treatise on this branch of prac-
tical medicine, which was originally written in French and
published at Paris in 1609, was soon translated into English
(''Childbirth, the Happy Deliverance of Women," London,
1612). In the opinion of von Siebold, podalic version may
justly be considered the most important contribution that
was made to obstetrical science during the sixteenth
century.

One of the French midwives of this period, Louise
Bourgeois (or Boursier), attained considerable celebrity
by the excellence of the treatise which she wrote on
obstetrics. She was born at Paris about the year 1564. In
1588 she began to fit herself for the career of midwife, and
in the course of a few years, after passing successfully the
required examinations, she was admitted by the authorities

RENEWED INTEREST IN MIDWIFERY 537

as a ''sworn midwife" of the city of Paris. She gained
steadily in experience and public favor, and the record
states that already as early as 1601 she had the good fortune
to officiate at the delivery of Henry the Fourth's wife
(Marie de Medicis) of -a son — the Dauphin (later, Louis
the Thirteenth). Her royal patrons were much pleased
with the services which she rendered on this occasion, and,
as a further evidence of the confidence which she inspired,
they asked her — as each of these occasions approached —
to preside at the births of five other children.

One of the meritorious features of the treatise which
Louise Bourgeois wrote,^ says von Siebold, is to be found
in the fact that she championed most earnestly podalic
version. The book was translated into both German
(1644) and Dutch (1658).

Frangois Mauriceau (1637-1709), who was indisputably
the most distinguished writer on obstetrics of the seven-
teenth century, was born in Paris. During the early part
of his career he was simply a general surgeon, but, after
the lapse of a few years, he gave up all his other work and
confined himself strictly to midwifery. For quite a long
period he held the position of Chief Obstetrician at Hotel-
Dieu, and at the same time he conducted an extensive
private practice in cases of confinement. Worn out by the
excessive amount of work which he performed during the
most active period of his career, he was finally obliged to
retire from practice several years before his death.

Mauriceau did not invent any remarkable obstetric
instruments or procedures, but he was the first to set forth
in clear and precise terms the principles of this science and
art and to expound the rules required for putting them into
practice. The titles of his two most celebrated treatises
are the following: ^^Traite des maladies des femmes
grosses/^ Paris, 1668; and ^^Observations sur la grossesse
et V accouchement,^^ Paris, 1695. In 1706, three years
before his death, he also published '^Dernieres observations
sur les maladies des femmes grosses.''^

The first of the three books mentioned passed through five

1 " observations diverses sur la sUriliU, etc.," Paris, 1609.

538 GROWTH OF MEDICINE

editions during Mauriceau's lifetime, and there were two
reprintings after his death. A noticeable feature of the
work, says von Siebold, is the care which the author takes
to preface all his lectures with a detailed exposition of the
anatomical relations of the region concerning which he is
about to speak; and this custom, which he was the first to
introduce, has since then been followed by the great
majority of those who have written on the subject of
midwifery.

In the book which bears the title ^^Observations sur la
grossesse, etc.,^^ Mauriceau gives an account of his first and
only interview with the English obstetrician, Hugh Cham-
berlen, to whom is commonly accorded the credit of having
invented the first pattern of the obstetric forceps. From
this account it appears that on August 19, 1670, Mauriceau
was called to see a primiparous woman, thirty-eight years
old, who had already been in labor for several days, but
who had not yet been able, owing to the extreme narrowness
of her pelvis, to give birth to her child. (The case was one
of head presentation. ) As Mauriceau was not at all willing
to perform a Caesarian section, — which alone, as he be-
lieved, promised a way out of the difficulty, — Chamberlen,
who happened to be in Paris at that moment, was asked
to see the patient. He came at once, made a hasty exami-
nation, and declared that he needed only six or seven
minutes for effecting, by means of the method which he had
invented, the delivery. The patient was placed under his
charge and he proceeded to apply his method. Instead of
a few minutes, he spent three hours in the attempt to
accomplish this purpose, but without success; and then
admitted that it was impossible, in this particular case, to
effect delivery. At the end of twenty-four hours the woman
was dead. A postmortem examination revealed the fact
that the uterus was torn in several places and perforated
at one spot, all of which lesions had evidently been produced
by the instrument or instruments employed by Chamberlen.
*'To complete this story," adds Mauriceau, *4t should be
remembered that, six months before the occurrence of the
events just narrated, this physician had come to Paris

RENEWED INTEREST IN MIDWIFERY 539

from England, and boasted that he possessed a secret
method by means of which he could, even in the most
desperate cases of labor, promptly effect the delivery of
the child, and had told the King's Physician-in-Ordinary
that he would sell the knowledge of this secret for the sum
of 10,000 Thaler s (about $7500)."

One naturally hesitates about giving any measure of
credit to a physician whose professional conduct, as revealed
in his relations to Mauriceau's patient, is clearly that of
a charlatan. At the same time we are obliged to bear in
mind that in 1670 it was still possible for a physician or
surgeon to own a secret method of treatment and yet not
forfeit all consideration on the part of his professional
brethren. But at no time in the history of medicine has
such conduct as that attributed to Hugh Chamberlen (apart
from the question of ownership of a secret process) been
considered otherwise than reprehensible. However, as
there does not appear to have been an earlier claimant for
the honor of having invented the obstetric forceps, — crude
as it must have been in its first form, — it seems only fair
that Chamberlen should be granted undisputed possession
of this honor. During the eighteenth century — a period
with which the present volume has no concern — the
obstetric forceps underwent many alterations, and finally
was given, by Levret and Baudelocque in France, by
Smellie in England, and possibly also by Palfyn in Holland,
practically the form which it possesses to-day.

Before I finally dismiss the allied topics of obstetrics and
gynaecology, it seems desirable that I should add a few
remarks concerning two French surgeons who attained
considerable eminence in this special field, viz.. Portal and
Dionis.

Paul Portal. — Paul Portal, a native of Montpellier,
France, was a contemporary of Mauriceau and an excellent
obstetrician. He received his training under the best
teachers at Paris, and more particularly under the guid-
ance of Rene Moreau, Dean of the Paris Faculty of Medi-
cine (1630 and 1631) and Royal Professor of Medicine and
Surgery. He died in 1703. In the treatise which he pub-

■ /

540 GROWTH OF MEDICINE

lished at Paris in 1685 {^^La pratique des accouchements,
etc.'^) he lays down very strongly the maxim that the
surgeon or the midwife who has charge of a case of labor
should make no attempt to accelerate the efforts of Nature
until it becomes plainly evident that artificial assistance
is absolutely necessary. Portal cultivated the art of digital
exploration to a very high degree of excellence. In Chapter
VI., according to von Siebold, he expounds with great
clearness the dangers which result from a prolapse of the
umbilical cord. When this condition is discovered, no time
should be lost in delivering the child. **In narrating some
of his most remarkable cases Portal uses very simple and
clear language, and he puts on record many things which
in later years have been published as entirely new dis-
coveries. But, unfortunately, his immediate successors
were not disposed to profit from Portal's admirable
teachings." (Von Siebold.) The only translations of his
treatise into foreign languages that have been published
are one in Dutch (1690) and another in Swedish by Van
Hoorn (1723).

Pierre Dionis. — Pierre Dionis, who was born at Paris in
the early part of the seventeenth century, was in some
degree related to Mauriceau, the famous Parisian accou-
cheur. In 1673 he was appointed Royal Demonstrator of
Anatomy and Surgery at the institution known as the
'^Jardin-du-Roi,^^ and from this date onward, up to the
year 1680, he gave instruction regularly in these branches
of medical knowledge to large classes of students. He was
particularly distinguished for the clear and methodical
manner in which he handled the subjects upon which he
lectured. In the year last mentioned he was called to
Vienna to fill the position of Physician-in-Ordinary to
Maria Theresa, Empress of Austria, but von Siebold, who
is my authority for the present sketch, does not say for
what length of time he continued to hold this position. His
death occurred in 1718.

The earliest work published by Dionis bears the title:
^^Histoire anatomique d'une matrice extraordinaire,'*
Paris, 1685. (Description of a case of extra-uterine

RENEWED INTEREST IN MIDWIFERY 541

pregnancy.) Five years later he published the treatise on
human anatomy {'^L'anatomie de Vhomme, etc.,^^ Paris,
1690) upon which his celebrity largely rests. This book
passed through numerous editions and was translated into
Latin, Dutch and English (1723), and also Chinese; this
last piece of work being done by the Jesuit missionary.
Father Parrenin, at the request of Cam-Hi, Emperor of
China, who died in 1723. Another treatise, which perhaps
contributed, even more than did his Anatomy, to render
Dionis celebrated, is that which bears the title: ^^Cours
d' operations de chirurgie demontrees au Jardin-du-Roi,'*
Paris, 1707 ; and later translations into German, Dutch and
English. This book covers the entire field of operative
surgery, and its subject-matter is most methodically
arranged. It contains a large number of precepts which
are as sound to-day as they were two hundred years ago.
From the frequent mention which Dionis makes of the dis-
eases to which the teeth are liable, and from his descriptions
of the operations that may be performed for the cure or
relief of these disorders, one is justified in drawing the
conclusion that, at that early period, this branch of surgery
was not, as many suppose, abandoned entirely to charlatans.

CHAPTER XLIII

THE FIRST APPEARANCE OF SYPHILIS IN EU^
ROPE AS AN EPIDEMIC DISEASE.— MEDICAL
JOURNALISM.— THE BEGINNINGS OF A MOD-
ERN PHARMACOPOEIA.— ITINERANT LITHOT-
OMISTS

Toward the end of the fifteenth and during the early
part of the sixteenth centuries accounts concerning syphilis
began to be published in the medical literature of Spain,
Italy and France. The word ' * syphilis, " it is true, does not
appear in any of these records, for it had not yet been
coined; but the accounts themselves leave no room for
doubt that this was the disease to which the authors of
these records referred. The prevailing views with regard
to the origin and nature of syphilis differed somewhat in
the three countries named. In Spain, for example, it was
a common belief that the disease originated in an unfavor-
able conjunction of the stars^ and yet at the same time it
was generally admitted that it was a disease which be-
longed in the category of luxuries and might be avoided
if one were careful not to have intercourse with dissolute
women. For a brief period of time there were physicians
in all three of the Latin countries who maintained that
syphilis had been imported, in the first instance, from
America by the men who made the voyage with Columbus
and by the earliest Spanish explorers of South America;
but it was soon shown that this theory was not compatible

1 For a confirmation of this statement see the poem on syphilis ("Enfer-
medad de las Bubas") written by the Spanish physician Francesco Lopez de
Villalobos and published by him in 1498 at Salamanca. The employment of
mercurial inunctions is also mentioned in this poem.

APPEARANCE OF SYPHILIS IN EUROPE 543

with certain known facts — such, for example, as the pub-
lished reports made by the Spanish physicians Pintor and
Torrella,^ who describe cases of syphilis which they had
treated prior to 1493 (the year in which the first discoverers
returned from America). In Italy, according to Giovanni
da Vigo, the author of an excellent treatise on surgery
C^Practica in arte chirurgica copiosa/^ Eome, 1514), the
disease was first observed in Europe in December, 1494,
soon after the arrival of Charles the Eighth's (France)
army at Naples ; and only a short time elapsed before there
developed, as a result of this great accession of French
soldiers, a veritable epidemic of what then began to be
known quite generally as ^^ morbus gallicus^' or **the
French disease." The King himself, it is stated, was
among the number of those who contracted the infection.

So far as I am able to discover, the term * ' syphilis ' ' was
first introduced into medical literature by Fracastoro, the
distinguished physician of Verona, who published in 1530
a Latin poem bearing the title: ^^ Syphilis sive morbus
gallicus.'*^ These verses were received everywhere with
great favor, were translated into several modern languages,
and speedily put an end forever to the employment of the
insulting term ^^ morbus gallicus.^*

A few more words with reference to the origin and dis-
tribution of syphilis throughout the world may not seem
inappropriate in this place. J. K. Proksch, the author of
the most recent history of this disease,^ says it has been
fully proved that syphilis existed among the inhabitants
of India as long ago as during the Middle Ages, and he
adds that the evidence thus far collected justifies the
further belief that it was not an uncommon malady among
the ancient Greeks and Romans, and even among the
Babylonians and Assyrians. Doubtless a good deal of
what was called ** leprosy" in early times was in reality
syphilis. Another syphilographer — Raphael Fincken-
stein — makes the following sensible remarks about the

2 Physicians who had served at Eome as the regular medical attendants of
Pope Alexander the Sixth.

3 "Die Geschichte der venerischen Krankheiten, " Bonn, 1895.

/

544 GROWTH OF MEDICINE

efforts that have been made to ascertain the precise date
when this disease first appeared in Europe : — *

It is just as foolish to suppose that the date of the first appear-
ance of syphihs may be discovered as it is to hope that the disease
will ever entirely disappear. As long as wealth and idleness con-
tinue to exist, as long as there are men who remain unmarried and
women whose moral character is of a yielding nature, and as long
as it is not possible for the police to creep into every nook and
corner, just so long will licentiousness and indulgence in fleshly
lusts continue to disturb the peace of the community. These are
the conditions necessary to the development and spread of syphilis.

Some account of the treatment of this form of venereal
disease comes next in order. It is commonly believed, says
the author just quoted, that it was from the Spanish physi-
cians of the sixteenth century that we learned how to treat
syphilis by the methodical employment of mercurial
preparations. (See footnote at the bottom of page 542.)
He adds that there was published by Juan Almenar at
Venice, in 1502, a book which bears the title: '*A treatise
on the Morbus Gallicus, in which it is demonstrated how
the patient may be treated in such a successful manner
that the disease will never return, nor will any objectionable
lesions develop in the mouth ; and yet, during the progress
of the treatment, the patient is not required to remain in
bed." The author of this book, who was a resident of
Valencia, Spain, was a man of noble birth. His treatise
passed through eight successive editions, the last of which
was printed at Basel in 1536. Almenar 's plan of treatment
was to employ mercurial inunctions in such moderate doses
as not to induce salivation. If, at the end of a few days,
he saw evidences of an approach of this symptom, he
substituted baths and evacuant remedies (rhubarb and
senna) for a short time, and also prescribed a more
nourishing diet and the taking of various internal remedies.
Then, later, the inunctions were resumed. The exact
duration of such a course of treatment is not stated. So
far as I am able to judge from the account given by
Finckenstein, Almenar found it necessary in some cases

4"Zur Geschichte der Syphilis," Breslau, 1870.

APPEARANCE OF SYPHILIS IN EUROPE 545

to repeat the series of mercurial inunctions as many as four
times. His aim, in other words, was to accomplish a
radical cure of the disease, whereas his contemporaries,
who were mainly ignorant and uneducated physicians, were
satisfied to carry out a purely symptomatic treatment.
Morejon, the historian of Spanish medicine, expresses the
belief that Almenar was the first to use steam baths in the
treatment of syphilis. Both Hensler and Simon, the best
modern authorities with regard to the history of syphilis,
agree that Almenar 's inunction method of treating this
disease forms, notwithstanding its crudeness in certain
respects, the basis of all modern methods of the same
general character. Unfortunately, the physicians of a later
period did not follow the relatively mild and safe inunction
method advocated by Almenar, but so modified it for the
worse that it became a common thing for men to say that
the cure was worse than the disease.

A Few Special Advances Worthy of Note. — The begin-
nings of medical journalism belong to the second half of
the seventeenth century. In 1665, for example, there
appeared for the first time, a medical article in the ^^ Journal
des Scavans,*^ and during the same year similar articles
were printed in the ** Philosophical Transactions of the
Royal Society of London." According to August Hirsch
the earliest periodical that was devoted entirely to the
interests of the medical profession was the *^ Journal des
decouvertes en medecine,^^ which was first published in
1679 and continued, in 1680, under the title of '*Le Temple
d'Esculape.''^ Then followed soon afterward: *'Le Journal
■ des Nouvelles Decouvertes en .Medecine^' (1681-1683);
^'Le Mercure Savant^' (1684); *'Le Zodiacus Medico-
Gallicus^' (1680-1685), which was published in Latin in
Geneva, by Bonet; etc.

In addition to the more important advances in anatomy
and physiology that have already been mentioned on
previous pages, the following deserve to receive at least
a passing notice: In the department of anatomy and
physiology, William Briggs (1642-1704), one of the physi-
cians of St. Thomas' Hospital, London, published at

546 GROWTH OF MEDICINE

Cambridge in 1676, under the title of ' * Ophthalmographia, ' '
a most important contribution to the anatomy and physi-
ology of the eye ; and there were four other English anato-
mists who, during the seventeenth century, gained well-
merited credit by the original work which they did in the
fields of anatomy and physiology — viz., Thomas Willis
(1622-1675), Francis Glisson (1597-1677), Thomas Wharton
(1610-1673), and Nathaniel Highmore (1613-1684). The
part played by Germany in these gains in anatomy and
physiology, during the period now under consideration,
was chiefly that of a sympathetic recipient ; for the political
conditions at that time were entirely unfavorable to any
active participation on the part of the physicians of that
country. Early in the eighteenth century, however, they
began in earnest to do their share of work in advancing
the science of medicine.

The relationship of the physical sciences to the theory
and practice of medicine is not of an intimate nature, and
it will therefore not be necessary for me to do more than
briefly to enumerate the more important of the discoveries
of this character which occurred during the sixteenth
and seventeenth centuries.

Galileo (1564-1642), a native of Pisa, Italy, was the
creator of the science of motion, and he gave the first
satisfactory demonstration of equilibrium on an inclined
plane. He devised an imperfect species of thermometer,
a proportional compass, and the refracting telescope, by
means of which latter instrument he made a number of
other important discoveries in the domain of astronomy.
His pupil, Evangelista Torricelli (1608-1647), also a native
of Italy, discovered the barometer, and in addition arrived
at many fundamental truths in mechanics and hydrostatics.
Otto von Guericke (1602-1686), a native of Magdeburg,
Germany, invented the air pump. Sir Isaac Newton (1642-
1727), born at Woolsthorpe, Lincolnshire, one of the
world's greatest authorities in natural philosophy, was the
first to formulate clearly the law of gravitation. Edme
Mariotte (1620-1684), a native of Burgundy, France, was
the discoverer of what is commonly known as '* Mariotte 's

GROWTH OF PHARMACOLOGY 547

law" — i.e., a law of elastic fluids, according to which the
elastic force is exactly in the inverse proportion of the
space which the mass of fluid occupies. He also discovered
that the part of the retina at which it meets the optic nerve
is not capable of conveying the impression of sight. Finally,
■Denis Papin (1647-1710), a Frenchman, invented the first
steam engine, of an embryonic and not very practical type ;
for in this apparatus the piston floated on the water in a
separate cylinder.

The inventions which I have here briefly enumerated
represent the more important discoveries that were made
in physical science during the sixteenth and seventeenth
centuries.

The Beginnings of a Modern Pharmacopoeia, and One
of the Last Attempts of the Disciples of Galen to Maintain
Their Ascendancy in Therapeutics. — In the domain of
pharmacology the first attempt in modern times to organize
this department of practical medicine was made by an
apothecary in Barcelona in 1497, and was published by
him in printed form in 1521. (Von Gurlt.) This pharma-
copoeia was doubtless wholly unknown beyond the borders
of Spain. Not far from one hundred years later, — i.e., in
the early part of the seventeenth century, — Theodore
Turquet de Mayerne, who was born in 1573, in a small
village near the city of Geneva, made the second attempt
in modern times to organize the pharmacological depart-
ment of practical medicine. After showing quite early in
life a fondness for the study of chemistry, he devoted him-
self particularly to the investigation of the remedies that
are produced in the chemist's laboratory; the preparations
of antimony attracting his especial interest. A little before
this time the physicians of Paris were split up into two
strongly antagonistic parties as regards the propriety of
administering this metal in any form as a remedy; but
those who opposed its therapeutic employment finally
managed to secure from Parliament, in 1566, a decree
prohibiting its use. While this quarrel was in progress,
de Mayerne visited Paris (1602) and established himself
in that city as an independent lecturer on chemistry. As

548 GROWTH OF MEDICINE

the regular faculty still held the belief that the teachings
of Galen were the only safe guide for physicians to follow,
de Mayerne's action must have appeared to them like an
impudent challenge. In one of his writings he strongly
recommended the employment of antimonial preparations, —
remedies introduced originally by the much-hated Para-
celsus,— and he even went so far as to offer some for sale.
This was too much for the disciples of Galen to bear
without a protest, and consequently in 1603 the Parliament
issued a new decree, in accordance with which de Mayerne
was prohibited from practicing medicine in Paris. This
measure appears to have proved successful in putting a
stop effectively to his obnoxious teachings, for we learn
that shortly afterward he was known to be living in
London, where, in 1611, he was appointed the Physician-in-
Ordinary to King James the First, and later to Charles
the First. He died in 1655.

Jean Astruc, the distinguished French medical author
of the eighteenth century, speaks rather disparagingly of
de Mayerne's attempt to organize a pharmacopoeia. An
earlier, more successful, and much more creditable attempt
of this nature was made by Valerius Cordus, whose ^'Dis-
pensatorium pharmacorum omnium^ ^ was first published
at Niirnberg in 1535. This work, which subsequently bore
the title ' ^ Pharmacopoeia Augustana,^^ up to the year 1627
passed through at least seven editions and was utilized to
a greater or less extent by the authors or editors of nearly
all later pharmacopoeias. To go still further back, the
most ancient pharmacopoeia of which we have any knowl-
edge is that which bears the title of ^'Antidotarium
Nicolai,^' the author of which work was Nicolaus, the
President or Dean of the Medical School at Salerno. The
book was written originally during the first half of the
twelfth century, but it did not appear in print, at Venice,
until the year 1471, and then only in an incomplete form.
Quite recently a French translation of the book has been
made and published (1896) by Paul Dorveaux, of the Paris
School of Pharmacy. Most of the preparations there
described have long since been abandoned, but a few of

ITINERANT LITHOTOMISTS 549

them — such, for example, as citrine ointment, honey of
roses, oxymel, and oil of roses — are still to be found in
the pharmacopoeias of some nations.

Itinerant Lithotomists. — For an unknown number of
years preceding the sixteenth century it had been a well-
established custom for members of the medical profession
in France, and also, doubtless, in neighboring countries,
to intrust — as the Hippocratic oath enjoined — all cases of
stone in the bladder to expert lithotomists. Such special
knowledge and skill were not easily acquired, and so it
came about that there were very few individuals who were
acknowledged to be experts and who were really capable
of teaching the art, and these few guarded most carefully
the knowledge which they had gained. During the period
of time which we are now considering, certain members of
the Collot and Pineau families were the most distinguished
lithotomists in France, and the records show that in the
year 1600 Jehan Paradis and Nicolas Serre petitioned the
Government for official recognition of their special rights
to enjoy a monopoly of operative work of this character.
*'We ask that you give orders that all poor patients who
may apply to Hotel-Dieu (the great city hospital of Paris)
or to the Bureau-of-the-Poor for relief from stone in the
bladder, be turned over to our care for proper treatment.
The poor will receive this treatment gratis, and those who
can afford to pay will be charged a very reasonable fee.
And you will do well if you prohibit all other persons from
meddling with such cases in any manner. " In a document
bearing the date 1646 mention is made of four lithotomists —
Philippe and Charles Collot, Jacques Girault and Antoine
Ruffin — ^who had erected in the Faubourg Saint-Antoine,
Paris, a building which was intended to serve as a hospital
**in which, at any time during the entire year, those who
are afflicted with stone in the bladder may be lodged, fed,
nursed and subjected to proper treatment, — the poor
without charge of any kind, and the well-to-do at a proper
rate of remuneration."

In Franco's time (middle of the sixteenth century)
cutting for stone in the bladder was by no means an

550 GROWTH OF MEDICINE

uncommon operation, and was almost always performed
by itinerant lithotomists {'Hnciseurs'^). The CoUots had,
for many years, possessed almost a monopoly of this
business. Laurent Collot, who was the first one of the
family to engage in the work, was Eoyal Lithotomist in
1556, and handed down to his son all the knowledge on this
subject which he had acquired through long experience.
Frangois Tolet was another of these popular lithotomists
who flourished in Paris during the sixteenth and seven-
teenth centuries. He died in 1724 at the age of seventy-
seven. His treatise on lithotomy, which was published in
Paris in 1681, and subsequently passed through several
editions, is said by Dezeimeris to contain the records of a
large number of his own cases and to show clearly that he
was a surgeon of sound judgment. No better treatise on
this subject, he adds, was published during that period of
the history of medicine.

In addition to those whom I have just mentioned there
were two French monks who gained wide celebrity as
operators for stone in the bladder, viz., Frere Jacques de
Beaulieu and Frere Come. The last-named belongs to the
early part of the eighteenth century, and should therefore —
in accordance with the plan which I have been following —
not receive consideration in the present account; but, in
view of the fact that these are the only two monks who,
during the Renaissance and the period immediately fol-
lowing, gained conspicuous credit for the honorable and
efficient service which they rendered, not merely to the
science of medicine but also to the cause of humanity, I
believe that I cannot do better than to place the two
sketches together as if they both belonged strictly to one
and the same period of time.

{a) Frere Jacques — or Brother James, who was born in
1561 at the village of Letendonne, near Lons-le-Saulnier,
Central France, — learned the art of operating for stone
in the bladder from an Italian surgeon named Paulony, and
acted as his assistant or associate up to the time when he
became a monk of the Order of Saint Francis — that is, of
that branch of the Order which had its chapter house at

FIG. 26. FR^RE JACQUES DE BEAULIEU.

Born in 1551 in the village of Letendonne, Franche-Comte, France.

(From the steel engraving in the treatise De la Taille Lalirale par le PirinSe, etc.,
by Pascal Baseilhac, nephew of Fr6re Come, Paris, 1804.)

ITINERANT LITHOTOMISTS 551

Feuillants in Languedoc. He traveled about the country
offering to treat gratuitously all persons affected with
stone in the bladder who were willing to trust him, and he
made it a rule, whenever such a thing was possible, always
to operate in the presence of one or more physicians or
surgeons. He was also ready at all times to give instruction
to those who wished to learn his method of procedure. He
never asked to be remunerated, but was always pleased
to receive from his patients a written testimonial of what
he had done for them. Out of the moneys which he received
from the rich he retained only that which he required for
his own support and for the purchase of such instruments
as he from time to time required ; the balance he distributed
among the poor. He was very faithful in performing his
religious duties, and he succeeded in gaining the good will
and esteem of everybody with whom he had any dealings.

For a long time it was customary in France to credit
Frere Jacques (Fig. 26) with the invention of the lateral
method of operating for stone in the bladder. This, how-
ever, was an error, for Franco, on page 95 of E. Nicaise's
reproduction of the 1561 edition, describes this operation
clearly. It must therefore have been invented a long time
before Frere Jacques was born. The text (rendered into

English) reads as follows: the incision should be

made between the anus and the testicles, two or three
finger-breadths to one side of the commissure or perinaeum
[median line of the perinaeum]." This is said to be the
earliest clear description of the first step of the lateral
operation of which we have any knowledge.

In 1697, when Frere Jacques visited Paris, he had already
attained wide celebrity as a lithotomist ; the number of his
successful operations — all of which had been performed
according to the lateral method of procedure — having
reached a grand total of several thousand. He therefore
had a right to suppose that his visit would prove acceptable
to the physicians of that metropolis; but the published
account of this visit reveals plainly the fact that the sur-
geons of that city were not at all pleased that an itinerant
lithotomist from one of the provinces should have the

552 GROWTH OF MEDICINE

effrontery to request permission of the authorities to
exhibit his method before the Medical Faculty of Paris.
His request, however, was granted, and he was allowed
to operate on a man, forty years old, at Hotel-Dieu. He
performed the operation before a large assembly of physi-
cians, and, after the stone had been successfully extracted,
the patient made a prompt recovery. A short time after-
ward he operated upon another patient at Fontainebleau
in the presence of several physicians, one of whom was
Monsieur Felix, the First Surgeon of the King, Louis the
Fourteenth. In this case also, as well as in several later
cases, Frere Jacques was entirely successful, and he now
began to be treated by the public with marked consideration.
But, in a short time, owing to the jealousy exhibited by
a large clique of Paris surgeons, who were encouraged to
pursue this course by Mery, the Head Surgeon of Hotel-
Dieu, Frere Jacques was finally forced to leave Paris. I
cannot follow him on his further wanderings throughout
Europe, from the leading cities of Holland, Belgium and
Switzerland to Vienna and Eome. In 1716 he retired to
Besangon and lived there quietly up to the time of his death
in 1719. But even then his enemies — men to whom he had
never done the slightest harm — did their best to destroy
the last traces of his existence. A visit made to Besangon
by one of his acquaintances not long after our Franciscan
monk's death, revealed the fact that his name had been
erased from the church registry of deaths. The lateral
method of operating for stone, which had been revived and
thoroughly developed by him, still finds favor among the
best surgeons of our own day; and the names of those
mean-spirited men who tried so hard to injure him have
long since passed into complete oblivion.

{h) Frere Jean de Saint-Come, — or Brother John of
Saint Cosmas, — ^whose real name was Jean Baseilhac, was
born in 1703 at Poyestruc, Department of Hautes-Pyrenees,
France. He received his instruction in the principles of
medicine from his father and his grandfather, both of
whom were regularly enrolled Masters in Surgery. In 1722,
when there could no longer be any doubt about young

^3'i*-

JEAN BASOLllAC, Hit FVore COMUl,
Kclio~l'<»iivHfini .no" on jyo5 A P()K.IAST1U'C <•» Bia-oiio

irt cm litliotomTa© ainplirtravit^ct perfccil.

FIG. 27. JEAN BASEILHAC, COMMONLY KNOWN IN

FRANCE AS FR^RE COME.

(From the steel engraving in Pascal Baseilhac's treatise.)

w

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O ^

w -B

-w 2

fa -"

>* I

PQ is

5 a
til bo

^ -i

2 ^

O M

a §

6 «

fH .a

^ i

U fa

o
o

554 GROWTH OF MEDICINE

Baseilhac's settled purpose to fit himself for the practice
of medicine, his father sent him to Lyons, where his uncle,
who was himself a surgeon, would be able to superintend
the boy's further training. Through the latter 's influence,
young Baseilhac was allowed to enter the Hotel-Dieu of
that city as one of its regular pupils. At the end of two
years — i.e., in 1724 — he left Lyons and went to Paris, where
he hoped to add materially to his stock of professional
knowledge. His first step, after reaching the metropolis,
was to enter the service of a surgeon in active practice;
and then, aided by the latter 's influence, he succeeded (in
1726) in entering the Paris Hotel-Dieu as one of the regular
pupils. Soon after he had completed his term of service
at the hospital, he was appointed Physician-in-Ordinary to
the Prince-Bishop of Bayeux, in Normandy. The death of
the latter in 1728, less than two years after Baseilhac had
entered his service, came as a great blow to the young
surgeon, for he had learned to esteem him very highly.
In his will the Bishop left a small legacy to Baseilhac —
that is, a sum of money sufficient to pay for the regular
course of instruction at the Medical School of Saint Cosmas
in Paris, and also to procure a complete outfit of surgical
instruments. In 1740 he became a member of the Feuillants
Branch of the Franciscan monks, it being understood,
however, that he was to be allowed the special privilege of
practicing surgery among the poorer classes. Through
accidental circumstances he was led gradually to drop
general surgery and to confine his work to operations for
stone. His official name at this time was '^Frere Jean de
Saint-Come," or simply ^'Frere Come." (Fig. 27.) As
he gained in experience as a lithotomist, he became con-
vinced that the method which his predecessor, Frere
Jacques, had practiced with such great success, was prefer-
able to the more complicated and more dangerous plan
commonly pursued by surgeons at that time, and thereafter
he adopted it in all his cases. But he modified the procedure
to a certain extent; that is, he invented an instrument by
means of which the actual cutting of the perinaeum was
accomplished with a concealed knife (see Fig. 28). The

ITINERANT LITHOTOMISTS 555

chief advantage to be gained by the employment of this
instrument consisted — as was claimed by Frere Jean and
his nephew, Pascal Baseilhac, — in the fact that in this way
the danger of making the incision in the wrong place, or
of too great length, was materially diminished.

The first patient upon whom the new instrument was
tried (October 8, 1748), was a dealer in lime, sixty years
of age and in rather delicate health. In less than three
weeks after the operation, he was entirely cured. Subse-
quently the instrument was employed in a large number
of instances, and the method was found to be most satis-
factory; successful results being obtained — on the aver-
age— in twelve out of thirteen cases, whereas the best
results previously obtained by the method commonly
employed at that period was 50 per cent of cures. At a
still later date the statistics showed even better results —
viz., 96 cures in one group of 100 cases, and 316 cures in a
second group of 330 cases.

Owing to the rapidly increasing number of patients
affected with stone in the bladder who wished to be
operated upon by Frere Jean himself, he established in
Paris in 1753, near the Saint Honore gateway, a special
hospital for lithotomy cases, and kept it in active service up
to the time of his death. The laboring classes, and the poor
in general, were not expected to pay any fees, and indeed
money was often bestowed upon these people when they
left the hospital, to enable them to return comfortably to
their villages ; those in moderate circumstances were asked
to pay only the expenses that had been incurred in their
behalf; and the well-to-do made such voluntary contribu-
tions as they thought proper toward the support of the
hospital. The registers of the institution showed that, first
and last, over one thousand operations had been performed
there, either by Frere Jean or by his nephew, Pascal
Baseilhac. Our monk's death occurred on July 8, 1781.

THE END

i'J

1

LIST OF THE MORE IMPORTANT AUTHORITIES

CONSULTED

ARISTOTLE : History of Animals, translated by Richard Cress-
well, London, 1902.
ASCHOFF, L. : Kurze Uebersichtstabelle zur Geschichte der

Medizin; forms the second part of Schwalbe's treatise {q.v.).
BAAS-HANDERSON : History of Medicine, New York, 1910.
BASEILHAC, PASCAL : De la Taille Lat^rale par la P]^rin6e,

et celle de l'Hypogastre, ou Haut Appareil/^ Paris, 1804.

(Includes an account of the career of Frere Come.)
BERENDES, J. : Das Apothekenwesen, Stuttgart, 1907.
BOERHAAVE : A New Method op Chemistry, translated by

Peter Shaw, M.D., London, 1741; Aphorisms, etc., English

translation, London, 1742,
BOTTEY, F. : Trait^ th^orique et pratique d'hydroth^rapie

Mi^DiCALE, Paris, 1895.
BROUSSAIS, F. J. V. : Examen des doctrines m^dicales,

troisieme edition (4 vols.), Paris, 1829-1834.
CABANES: Paracelse — L'homme et l'oeuvre, article in La

Revue Scientifique, Paris, May 19, 1894.
CASALIS : De profanis Romanorum ritibus ; Chapter VII., de

Aesculapio, Rome, 1644.
CELSE, A. C. : Trait]6 de M^decine; traduction par le Dr. A.

Vedrenes, Paris, 1876.
CHEREAU: Les Anciennes Ecoles de M^decine de la Rue de

LA BucHERiE, Paris, 1866.
CULLEN, WILLIAM : First Lines op the Practice of Medicine,

Edinburgh, 1802. (2 vols.)
DAREMBERG, CHARLES: Oeuvres anatomiques, physiolo-

GiQUES ET m^dicales DE Galien, 2 vols., Paris, 1854-1856 ; Etat

DE LA m^decine entre Homi^re ET HippocRATE, Paris, 1869;

HiSTOiRE DES SCIENCES Mi^DicALES, 2 vols., Paris, 1870.
DEZEIMERIS, OLLIVIER ET RAIGE-DELORME : Diction-

NAiRE Hist, de la M6d. Anc. et Mod., 3 vols., Paris, 1828-1837.

558 LIST OF AUTHORITIES

DIOSKURIDES, PEDANIOS : Arzneimittellehre, Uebersetzimg
von Dr. J. Berendes, Stuttgart, 1902.

DORVEAUX, PAUL: L 'Antidotaibe Nicolai (Nicolaus Prae-
POSiTus), Paris, 1896.

FALK: Galenas Lehre vom gesunden und kranken Nerven-
SYSTEME, Leipzig, 1871.

FINCKENSTEIN : Zur Geschichte der Syphilis, Breslau, 1870.
FOSSEL, VIKTOR: Hieronymus Fbacastoro; drei Buecher

VON DEN CONTAGIEN, DEN KONTAGIOESEN KrANKHEITEN UND

DEREN Behandlung (1546), Leipzig, 1910.
FRANCO, PIERRE : Chirurgie, Nouvelle edition par E. Nicaise,

Paris, 1895.
FREIND, J. : The History of Physick, 2d edition, London, 1727.

(2 vols.)
FRIEDLAENDER, L. H. : Vorlesungen ueber die Geschichte

der Heilkunde, Leipzig, 1839.
FROELICH, H. : Galen ueber Krankheitsvortaeuschungen, in

Friedrieh's Blaetter fuer Gerichtliche Mediein, I. Heft, vier-

zigster Jahrgang, Nuernberg, 1889.
GERMAIN, A.: L'Ecole de M^decine de Montpellieb, Mont-

pellier, 1880.
GUERINI : A History of Dentistry, etc., Philadelphia and New

York, 1909.
von GURLT: Geschichte der Chirurgie, Berlin, 1898. (3 vols.)
GUY DE CHAULIAC : La Grande Chirurgie, edited by Edouard

Nicaise, Paris, 1890.
HAESER, H. : Lehrbuch der Geschichte der Medicin, zweite

Ausgabe, Jena, 1868. (3d edition, 1875.)
von HALLER, ALBERT: Bibliotheca medicinae practicae,

Basel, 1776. (4 vols.)
HERODOTUS: History, translated by George Rawlinson, M.A.

(2 vols.)
HIPPOCRATES: Saemmtliche "Werke, translated into German

by Dr. Robert Fuchs (3 vols.), Munich, 1895-1900.
HIRSCH, AUGUST: Geschichte der med. Wissenschaften in

Deutschland, Muenchen und Leipzig, 1893.
HOLLAENDER, EUGEN: Die Medizin in der klassischen

Malerei, Stuttgart, 1903; Plastik und Medizin, Stuttgart,

1912.

LIST OF AUTHORITIES 559

HOMER : The Iliad and the Odyssey, published by Dent & Sons,
London. (2 vols.)

HYRTL, JOSEPH: Lehrbuch der Anatomie des Menschen,
Vienna, 1846.

JUSSERAND, J. J.: English Wayfaring Life in the Middle
Ages (14th century), G. P. Putnam's Sons, New York and
London, 1889.

LABOULBENE, M. A. : Syndenham et son oeuvre, article in the
Revue Scientifique, Tome XL VIII, November 28, 1891.

LE CLERC, DANIEL: Histoire de la M^decine, Amsterdam,
1723.

LE CLERC, LUCIEN: Histoire de la Medecine Arabe (2 vols.),
Paris, 1876.

LEMOINE, ALBERT: Le Vitalisme et l'Animisme de Stahl,
Paris, 1864.

MALGAIGNE: Oeuvres completes d'Ambroise Par^, 1840-1841,
(3 vols.)

MEYER-STEINEG : Cornelius Celsus ueber Grundfragen der
Medizin, Leipzig, 1912; Kranken-Anstalten im griechisch-
roemischen Altertum, Jena, 1912.

voN MEYER, E. : Geschichte der Chemie, 3d edition, Leipzig,
1905.

MOMMSEN, THEODORE: The History of Rome, translated
from the German by W. P. Dickson and published by Dent
& Sons, London.

MUENZ, ISAAC : Ueber die juedischen Aerzte im Mittelalter,
Berlin, 1887.

NEUBURGER, ALBERT : Friedrich Hoffmann ueber das
KoHLENOXYDGAS, Leipzig, 1912.

NEUBURGER, MAX: Geschichte der Medizin, Vol. I. and
Vol. II., zweiter Theil, 1906-1911.

OPITZ, KARL : Die Medizin im Koran, Stuttgart, 1906.

ORDRONAUX, JOHN : Regimen sanitatis Salernitanum, trans-
lated into English verse, Philadelphia, 1871,

PAGEL, JULIUS : Einfuehrung in die Geschichte der Medicin,
Berlin, 1898.

PESSINA VON CECHOROD, W. M. : Heilige Aerzte und
Pfleger der Kranken^ Brag, 1859.

560 LIST OF AUTHORITIES

PETERSEN, JULIUS: Hauptmomente in der geschichtlichen

Entwickelung der medicinischen Therapie, Copenhagen,

1877.
PLATO: The Republic, Timaeus, and Critias, translated by-
Henry Davis, London, 1911.
PLATTER, FELIX ET THOMAS, a Montpellier (1552-1557;

1595-1599), Montpellier, 1892.
PRISCIANUS, THEODORUS : uebersetzt von Dr. Meyer-Steineg,

Jena, 1909.
PUSCHMANN, THEODOR: The Original Greek Text and a

German translation of Alexander of Tralles, Vienna,

1878; and Geschichte des medicinischen unterrichts,

Leipzig, 1889.
RUFUS D'EPHESE: Oeuvres, traduites par Daremberg et

Ruelle, Paris, 1879.
RENAN, ERNEST: Averro^ss et l'Averroisme, 2me edition,

Paris, 1861.
SALICET, GUILLAUME DE : Chirurgie, traduction par Paul

Pifteau, Toulouse, 1898.
SCHWALBE, ERNST: Vorlesungen ueber Geschichte der

Medizin, 2te Auflage, Jena, 1909.
SIEBOLD, E. VON: Versuch einer Geschichte der Geburts-

HUELFE (2 vols.), Berlin, 1839.
SOUTH, JOHN FLINT : Memorials of the Craft of Surgery in

England, edited by D'Arcy Power, M.A. Oxon., F.R.C.S.

Eng., 1886.
SPIESS, G. A.: J. B. Van Helmont's System der Medicin,

Frankfort am Main, 1840.
SPRENGEL, KURT : Versuch einer pragmatischen Geschichte

der Arzneikunde (5 vols.), Halle, 1821-1828.
TACITUS : The Annals, edited by E. H. Blankeney, Dent & Sons,"

London.
TSINTSIROPOULOS, CONSTANTIN: La m^decine Grecque

DEPUis Ascl:6piade jusqu' a Galien, Paris, 1892.
WELLMANN, MAX : Die pneumatische Schule, Berlin, 1895.
WISEMAN, RICHARD : Eight Surgical Treatises, 5th edition,

London, 1719.

,'tl

GENERAL INDEX

<,-w^

i'^J

GENERAL INDEX

Abdomen, penetrating wounds of, 469

Abella, teacher of medicine at Sa-
lerno, 245

Abou Bekb, distinguished Arab physi-
cian in Spain, 232

Abou Sahl el Messihy, distin-
guished Persian physician, 223

Abscess, mediastinal, 229

Abulcasis, famous Arab surgeon,
226

Abulpharagius, 184

AcAD^MiE DE Chirxjegie, Paris (1731),
450

ACADl^MIE DES CURIEUX DA LA NATURE,

364
ACAD^MIE DES SCIENCES, 363
ACCADEMIA DEI LiNCEi, Eome, 364
AccADEMiA DEL CiMENTO, Florence,

364

ACRABADIN KebIR, 209

Acupressure, 143
Adams, Frederick, 89
Aegidius Corboliensis, 255
Aeneas, wounded in groin, 49
Aesculapius, 47, 49

symbol of, 315

temple of, at Cos, 514
Aetius, 194, 318
Afplacius, John, 245, 248
Agathinus, 142
Agbate, Marco, 339
AiGLE, daughter of Aesculapius, 50
Alae nasi, Galen's comments on

movements of, 173
Albert von Bollstedt (Albertus

Magnus), 269
Alcmaeon, 73, 79
Alderotti, Thaddeus, 272

Alexander of Tealles, 195

Alexander Philalethes, 115

Alexander the Great, 100

Alexandria, Egypt, 100, 116

Alhazen, researches in optics, 233

Alkaloids (quintessences of Para-
celsus), 405

Almansub, Caliph of Bagdad, 184,
203

Almenar, Juan, 544

Alphanus II., Abbot of Monte Cas-
sino, 239

Alsaharavius, 227

ALU, 13

Amatus Lusitanus, 484, 487

Ambrosia, antidote for poisons, 112

Amputation of leg (Fig.), 463

Amrou, 116, 185

Amulets and other magical reme-
dies, 197

Anaesthesia, Surgical, from em-
ployment of soporific sponges,
253, 462

Anatomical demonstrations at Sa-
lerno, 253

Anatomical specimens, preserva-
tion of, 356

Anatomy and physiology, impor-
tant discoveries during 16th cen-
'tury, 353

Anatomy, importance of study of,
312

Anatomy, microscopic, 360

Anaximander, 72

Anaximenes, 72

Andreas of Cakystus, 114

Animism, 405, 432

Antidotarium, early name for phar-
macopoeia, 319

Antidotarium Nicolai, 548

564

GENERAL INDEX

Antimony, curative action of, 158,

548
Antiochus, cured by Erasistratus,

106
Antoninus Pius, 57
Antrum of Hiqhmore, 359
Antyllus, 143, 201
Apes, dissection of, 164
Apollo, the god of medicine, 18, 50
Apollonius Mus, 111
Apothecary, 316, 319
Apparatus magnus (operation for

stone in the bladder), 474
Apuleius, Lucius, 120, 126
Aqua vitae, how prepared, 313
Arabian physicians, dogmatism of,

412
Arab renaissance, 203, 217, 233, 259
Arantian operation, a substitute for

Tagliacotian operation, 481
Aranzio or Arantius, 349, 481
Arceo, Francisco, 484, 486
Archaeus influus and Archaeus

INSITUS, 399

Archagathus, 119
Archigenes, 142, 174

on ligation of larger blood-vessels

before amputation of a limb, 470
Archimathaeus, 248
Arderne, John, 307
Aretaeus, 144
Aristophanes, 58
Aristotle, 73, 102, 433

commentary by Averroes, 229
Arnold, of Villanova, 292-296
Arrow, extraction of, from chest

during battle (Fig.), 461
Ars parva, of Galen, 248
Arteries, ligaturing of divided, after

an amputation, 289
Arteriotomy, for relief of hemi-

crania, 470
Artery forceps devised by Ambroise

Par 6, 512
AsAKKU, the demon who produces

fever in the head, 13

Asclepiades, founder of a new sect

at Eome, 116, 119, 122
AsCLEPiEiA, 50, 52, 57
AscLEPiEioN at Cos (Figs.), 53

at Epidaurus, 52
AsELLi, Caspar, 385
Assyrian medicine, 11
Astringents, 133
Astrologer, a typical, 12
Astrologers in Babylonia, 14
AsTRuc, Jean, 548
Athenaeus, founder of sect of

Pneumatists, 141
Athens, a great medical centre, 96

epidemic of the Plague at, 96
Athletic exercises as a therapeutic

measure, 69
Athotis, 17
Augustus, Eoman Emperor, cured of

gout by hydrotherapy, 129
Auricles of the heart, comments

on, by H. de Mondeville, 290
Auscultation of the chest, 20, 159
AusTKiCHiLDis, King Guntram's wife,

240, 241
Authors, numerous in Cordova in

12th century, 232
Averroes, pupil of Avenzoar, 229
averboism, 267
Avenzoar, 228
avicenna, 221

B

Babylonia, genuine remedial agents

employed in, 13
Babylonian astrologers, 14
Babylonians, strange beliefs held by,

in regard to human anatomy and

physiology, 13
Bacon, Francis, 338
Bacon, Eoger, 271
Bacteriology, first studies in, 362
Bagdad, a second great hospital

founded at, in A. D. 914, 219
Bain, Christopher, 396
Bakhtichou ben Djordis, 205, 207

GENERAL INDEX

565

Bakhtichou, George, 205

Barbaric Latin, 262

Barbers, the earliest surgeons in

France, 530
Barbers and Barber-Surgeons, 282,

369, 449, 464
Barber-Surgeons ' Company, of

London, 519
Bartholomaeus, 245
Baseilhac, Jean, 552
Baseilhac, Pascal, 496
Basel, public dissection of human

body at, 455
visited by Vesalius in 1542, 455
Baths extensively used by ancients,

157, 323
Baudelocque, 539
Bede, The Venerable, believed in

cures by supernatural means, 241
Belladonna, when first used for di-
lating the pupils, 157
Benedictine monastery on Monte

Cassino, 238
Beniveni, Antonio, 389, 498
Benvenuto Cellini, 341
Berendes, 159, 317, 322, 426
Berengarius of Carpi, 342, 374
Bernardo di Rapallo, 472
Bertharius, abbot of Monte Cas-
sino, 239
Berthelot, on Geber, 320
Bertrucius, 310
Bile, black and yellow, 86

manner of production, 109
Bladder, tuberculous ulceration of,

200
Blancaard, Stephen, 359
Blood, inflammation of (Sydenham),

423
production of, according to Erasis-

tratus, 109
spirituous, 373
transfusion of, 408
Bloodletting, comments on, by Cel-

sus, 152
from a vein, technique, 152
how practice first originated, 6

rule of Hippocrates regarding, 411
under what circumstances advis-
able, 133

Blood-vessels, Capillary, circula-
tion in, 383
when first injected artificially, 356,
359

Boerhaave, Hermann, 144, 438, 441
gives clinical instruction at Ley-
den, 430
treatise on chemistry the standard
for many years, 440

Boiling of drinking water prac-
ticed by ancient Persians, 26

Bologna Medical School, 272, 281,
332

Boniface VIII., Pope, successfully
treated for stone in the bladder,
293

Books, great demand for, in 15th
century, 329

BoRELLi, Alphonso, 368

BoTALLO, Leonardo, 413

Botanical gardens, 17, 392, 393

Bougies, xtrethral, 495

Bourgeois, Louise, 536

Boyle, Robert, a distinguished chem-
ist, 406

Branca, father and son, skilled in
rhinoplasty, 459

Brassavola, experimental pharma-
cologist, 398

Breviarium, Arnold's, 294

Briggs, William, 545

Brissot, Pierre, 411

Bronze surgical knives, 16

Browne, Andrew, the friend of
Sydenham, 422, 424

Brunner, Johann Conrad, 359

Brunschwig, Hieronymus, 456

Brunus, 277

Bullets not hot when they enter the
flesh, 513

BuRiNNA, name of spring on the
Island of Cos, 54

Byzantium, the new capital of the
Roman Empire, 180

566

GENERAL INDEX

Cabanas, 402

Cacao, 395

Caelius Aurelianus, 132, 159

Caesar, Julius, liberality of, toward
foreign physicians settled in
Eome, 119

Caesalpinus, Andreas, 372, 375, 394

Caesarian section, 396, 534

Cairo physicians distinguished oph-
thalmologists, 225

Calcar, Vesalius' draughtsman, 344

Calculus in the bladder may not be
dissolved by internal remedies,
498

Callidum innatum of Hippocrates,
415

Calvin, John, visited by Felix Plat-
ter, 335

Cancer of breast, sculptured in
marble (Fig.), 68

Cancer, ulcerated, not to be cau-
terized, 285

Cannani, 378

Canon, the, of Avicenna, 222

Capsicum, 395

Caraka, East Indian medical author,
31

Carbonic acid, nature of, expounded
by Van Helmont, 400

Carbonous oxide, 434

Carcano Leone, 475, 476

Case histories recorded on tablets,
67

Cassiodorus, 238

Castor oil, perfected by Apollonius
Mus, 111

Cataract operations of Pierre
Franco, 494

Cato, Marcus Porcius, 117, 235

Caustics, too freely used as haemos-
tatics, 466

Cauterization of ulcerated cancer
not approved by Lanfranchi, 285

Cauterizing instruments, 279

Celsus, Aulus Cornelius, 150, 151,
155

Cerebral nerves, crossing of, in re-
lation to paralysis of one side of
the body, 144

Cermisone, Antonio, 313

Chamberlen, Hugh, 538

Chaldean doctrine of numbers, 74

Charcoal, fumes of burning, 435

Chaucer's account of a clever
physician, 308

Chemical element defined, 407

Chemistry in ancient Egypt, 17
modern, developed gradually from
alchemy, 320

Chicory an effective remedy in
abdominal diseases, 109

Chinese conceptions concerning
human physiology, 41

Chinese medicine, 38, 39

Chiron, 48

Christianity, influence of, upon evo-
lution of medicine, 179

Chrysippus, 141

Chyle, distribution of, after it leaves
the stomach, 109

Chyle ducts, discovery of, 385

Cicero's interpretation of the ex-
pression "gods" as employed by
the ancients, 18

Cinchona, discovery of, 408

Circa instans, the title commonly
given to treatise of Matthew
Platearius, 253

Circulation of blood, Galen's
physiology of, 373
de Mondeville's comments, 289

Citizenship, rights of, bestowed by
Julius Caesar on all foreign
physicians practicing in Eome,
119, 130

Civitas Hippocratica, 243

Claudius, Eoman Emperor, merciful
action of, toward slaves, 235

Clemens, of Alexandria, Egypt, 17

Clement IV., Pope, protects Eoger
Bacon, 272

GENERAL INDEX

567

Clement V., Pope, removes papal
seat from Eome to Avignon, 293

Clinical instruction at Leyden Hos-
pital, 429

Clowes, William, 519

Cnidian school op medicine, 81

Cnedus, in Caria, Asia Minor, 51

Coca, 395

Cold, exposure to, unusual treat-
ment of, 489

College of Physicians, London, 417

College op Saint Cosmas, Paris, 283,
284, 448

CoLLiGET, title of treatise written by
Averroes, 229

CoLOT, Laurent, famous French
lithotomist, 474

Columbus, Eealdus, 349

experiments relating to physiology
of heart, 377

C6me, Fr^re, 550

Communities, term employed by the
Methodists for designating the
two conditions "laxum" and
"strictum," 130

Compendium aromatariorum, the
first modern treatise on materia
medica, 320

Compendium Salernitanum, 246

Conciliator, title of one of Pietro
d'Abano's great works, 266, 267

Constantinople, taking of, by the
Turks, an important aid to the
advance of medicine, 328

CONSTANTINUS THE APRICAN, 239,

248, 260

Contagion, innate, 220

Contagious diseases, Fracastoro 's
classification of, 390

Continens, title of Ehazes' great
work, 220, 262

CoNTRARiA contrariis, principle of,
in therapeutics, 132

Cosmas and Damian, 282, 449

CoPAiVA, balsam op, 395

CoPHON, teacher of medicine at Sa-
lerno, 245

Cordova, Spain, centre of great in-
tellectual activity, 218, 232

Corpse, the touching of a, believed
by the Persians to produce a
special contamination, 25

Cos, Island op (Figs.), 53

Costa ben Luca, 215, 216

CosTANZA Calenda, 245

CowPER, William, 360

Croke, a., 250

Cronos, 19

Crotona, Italy, 51

CuLLEN, William, 432

Curtis, John G., 72, 140

Cyrene, in Lybia, Africa, 51

Cystotomy, hypogastric, 495

Damascus, an active medical centre

in the 13th century, 225, 232
Daremberg, 50, 75, 240, 420
Darius L, King of the Persians, 26,

75
David's harp-playing, effect of, on

King Saul's melancholia, 27
Da Vinci, Leonardo, 339
Daza Chacon, 484
De le Boe, Franz, 427
Db Marchettis, Domenico, 359
Demetrius, op Apamea, 114
Democedes, 73, 75
Democritus, 82

Demosthenes, op Marseilles, 115
Denys, of Paris, 408
Desiderius, Abbot of Monte Cassino,

•239
Dezeimeris, 341, 400
Dietetics of pregnant women, 199
Dieting and athletic exercises, 69
Dietz, Eeinhold, discoverer of an

early Greek manuscript of Sora-

nus, 138
Digestion, physiology of, according

to Erasistratus, 108
according to Aretaeus, 144
DioCLES, of Carystos, 103

568

GENERAL INDEX

DiONis, Pierre, distinguished French
anatomist, 41, 364, 383, 540

DioscoRiDES, Pedanius, 157, 317

Diphtheria, genuine, recognized by
Paracelsus, 405

Diphtheria, pharyngeal, known in
2d century as Syriae ulcer, 144

Diseases mentioned in the papyrus
Ebers, 20

Dislocation op shoulder, success-
fully reduced by Gabriel Bakhti-
chou, 207

Dissecting of human bodies, early
attempts, 309, 327, 331
practice approved by University of

Salamanca, 346
practice made obligatory in the
medical schools early in 18th cen-
tury, 364

Distempers of the stiff and elastic
fibres (Boerhaave), 442

Divine water of the alchemists, 321

Djondisabour, early establishment of
a medical school at, 184, 204

Doctor, when first employed as a
title, 280

DoDOENS, Eembert (Dodonaeus), 395

Dogmatists, sect of the, 101, 103,
149

DONATO, Marcello, 396

Don Carlos, of Spain, skull severely
injured, 485

DoRVEAUx, Paul, 548

Douglas, James, 361

Drachma, value of, 207

Draco, son of Hippocrates, 82

Dracunculus medinensis, 233

Drugs, enumerated by Homer in the
Odyssey, 18
enumerated by Dioscorides, 18
remedial effects of, 398

Dry treatment of wounds, 275,
285

DuBois, Jacques (Sylvius), the anat-
omist, 340, 345

Dysentery, East Indian treatment of,
409

E

Ear, cherry pit in, 396
fatal disease of, 489

East Indian surgeons performed
suprapubic cystotomy before the
Christian era, 497

Eben el Khammar, a distinguished
Persian physician, 222

Ebers papyrus, the, 20

Eclectics, the, 142, 149

Egypt, ancient, practice of medicine
in, 16, 17
process of embalming in, 17
temples were used as hospitals and
as medical schools, as well as for
purposes of worship, 19

Egyptians, the ancient, surgical
instruments used by, 21
surgical methods employed by, 21
therapeutics of, 20
they were good sanitarians, 23
they were the originators of many
of the Mosaic laws, 27

Eleatic school of philosophy, 73

Elbow-joint, exarticulation of, 508

Electric ray, shocks communicated
by, utilized in treatment of se-
vere headache, 155

Elisha the prophet cures Naaman's
so-called leprosy, 27

Embalming, Egyptian process of, 17

Emir Adhad Eddoula founds a great
hospital at Bagdad, 219

Empedocles (444 B. C.) places the
seat of the hearing in the laby-
rinth of the temporal bone, 80

Empirics, sect of the, 101, 111, 149

Encyclopaedists, the, 156

Epicureans, the, 102

Epidaurus, in Argolis, Greece, 51

Epione, wife of Aesculapius, 50

Erasistratus, 104, 106, 110

teachings of, with regard to nature
of the blood and the circulation,
371

Erasmus, on Linacre, 418

GENERAL INDEX

569

£tienne, Eobeet, 197

EUENOR, 99

EuLEE, Leonhard, 360

EuPORiSTA, title of Oribasius ' treatise,

192
EuPORiSTON, title of treatise by Pris-

cianus, 193
EUSTACHIUS, Bartholomaeus, 345,

348, 358, 384
Evil spirits, part played by, in pro-
ducing disease, 8
Exercise, physical, not absolutely

necessary to persons in normal

health, 125
Experience, great value attached to,

by Hippocrates, 148

Fabiola, the widow, established the
first hospital in Eome, 235

Eabricius ab Acquapendente, 349,
351, 378, 478

Fabricius of Hilden, 464

Facial hemiparesis, sculptured in
marble (Fig.), 68

Fallopius or Falloppius, Gabriele,
341, 348, 360, 393, 474, 478

Farragut, of Girgenti, Sicily, 262

Faust, Johannes, 322

Fedeles, Fortunatus, 398

Fees, medical, in Babylonia, 15

Fever, nature of, as taught by
Sydenham, 423

Feldbuch der Wundartzney, von
Gerssdorff 's, 462

Femur, fracture of, 510

Ferment in blood the cause of small-
pox (Ehazes), 220

Fernel, Jean, 414

FiLARiA Medinensis, removal of,
from boy's leg, 489

FiNCKENSTEIN, 543

Fistula in ano, John Arderne's

treatise on, 307
Flammula, 522
Flint knives, 9

Flos Medicinae, title of medical

treatise, 251
Flourens, 374
Foramen Botalli, 413
Forceps for crushing stone in the

bladder (Fig.), 497
Forceps, obstetrical, invention of, 535
FoREEST, Peter, 413
Formulary of Sabour ben Sahl, 209
FOSSEL, 391
Fra Sarpi, 378
Fracastoro, Hieronymus, 221, 362,

389, 391
Franco, Pierre, 490, 494, 495, 497
Franconian operation, revived in

1719 by John Douglas of London,

496
Frederick II., King of Sicily, pro-
motes work of translating from

the Arabic, 261
Freind, John, 184, 195, 416
FRiiRE Jacques de Beaulieu, 550
Friedlaender, 3

Gabriel, the most distinguished
member of the Bakhtichou fam-
ily, 207

Gaius, of Naples, a distinguished
opthalmologist, 115

Gale, Thomas, 517

Galeazzo di Santa Sofia, Professor
of Anatomy at Vienna, 311

Galen, Claudius, 74, 160, 316, 344
on the nature of the blood, 372
on the true function of respiration,

372
on the treatment of wounds, 275
treatises written by, 167

Galenic doctrines, 400

Galenical preparations, 317

Galenism, meaning of the term, 388

Galenists, English, in 17th century,
419

Galen's system of therapeutics still
used in Persia, 317

570

GENERAL INDEX

Galileo, 546

Gallu, the demon who causes dis-
eases of the hand, 13 •

Gabiopontus, a teacher at Salerno,
245, 247

Gas sylvestee, 401

Geber, credited with being the found-
er of chemistry, 233
now believed to be a mythical per-
sonage, 320

Gentile da Foligno, 266

Geeard of Cremona, 227, 261

Geem origin of certain febrile dis-
eases suspected by Ehazes, 221

Germany, devastated during the 17th
century, 426
medical education in (from 1400 to
1600), 454

Gerssdorff, Hans von, 460

Gesner, Conrad, 394

Gilbertus Anglicus, 305, 516

GiLLES DB CoRBEiL, on urology, 255

GlADIATOES, SCHOOLS FOE, 68

Glaubee's salt, 410
Glisson, Feancis, 358, 546
Glossulae quatuor magistroeum,

280
GORDONIUS, 296

Gourdon, Bernard de (Gordonius),

296
Gout, remedy for, recommended by

Aetius, 195
Graaf, Keigniee de, 359, 361
Grapheus, Benevenutus, celebrated

eye surgeon of the 12th century,

256
Graves, robbing of, for dissecting

material, 309, 332, 336
Geeat Britain, condition of surgery

in, during 16th and 17th cen-
turies, 516
Greek peoveebs relating to medicine,

77
Geegoey, Bishop of Toues, 241
Geiffon, Jean, distinguished Gene-

vese surgeon, 464

GuAiAC, inefficient anti-syphilitic rem-
edy, 405

GuAiNERio, of Pavia, 496

GUARNA, Eebecca, 245

GuERicKE, Otto von, 546

GuiDO GuiDi (Vidus Vidius), the
anatomist, 340

GUILLEMEAU, Jacques, 536

GuiscARD, Egbert, a resident at Sa-
lerno, 240

GuLDiNus, Paul, 409

Gunpowder, first employment of, in
European warfare, 328

Gunshot wounds, 467, 473

GuELT, von, 455

Guy de Chauliac, 227, 263, 298, 299,
310
founder of didactic surgery, 300
manner of treating injured nerves,

302
manner of treating fractures of the
thigh, 304

Gymnastic exeecises, institutions
for cultivating, 68

Gynaecologists, eaely, 115

Gynaecology successfully practiced
by Soranus, 140

H

Hallee, Albeet von, 142, 344

Haly, Abbas, a Persian physician
and the author of the famous
treatise called "Al-Maleky" —
' ' The Eoyal Book, ' ' 223

Hammueabi's law with reference to
physicians' fees in Babylonia, 15

Haederwyk, University of, 439

Haroun Aleaschid, 206

Haevey, William, discoverer of the
circulation of the blood, 379

Head, injueies of (Wuertz), 467

Heart, anatomy of, according to de
Mondeville, 289
physiology of, 377

Heidelberg, University of, 454

Heliodorus, 202

GENERAL INDEX

571

Helvetius, 409

Hemorrhage from a wound, differ-
ent means of arresting, 154, 277

Henry the Second's manner of
death, 511

Henschel, researches of, 246

Herakleides, of Tarentum, 111

Hercules an ancestor of Hippocrates,
81

Hermetic books relating to medicine,
18

Hernia, radical cure of, by mem-
bers of the Norsa family, 482

Hernia-healers, 490

Herodicus, of Selymbria, 69

Herodotus, a different person from
the famous historian, 26, 142

Herophilus, a distinguished physi-
cian of Chaleedon, 104

Herzog, excavations made by, at Cos,
55

Hesychios, 201

Heurnius, Johannes, clinical teacher
at Leyden, 429

High operation for stone in the
bladder {le haut appareil), 495,
496

Highmore, Nathaniel, 359, 546

Hindu physicians held very crude
ideas about pathology, 31

Hippocrates the Great, 81, 82, 98,
411

HiPPOCRATIC OATH, 71

HippocRATic WRITINGS, French ver-
sion of Littr6, 83
German version of Fuchs, 84
short extracts, 89

Hirsch, August, 399, 545

Hobeich, 215

Hofmann, Moritz, 358

Hoffmann, Friedrich, 431, 434

Hoffmann's anodyne, 437

Homeric poems probably written
about B. C. 800, 46

Homer's familiarity with anat-
omy, 48

HONEIN, 208, 212, 214, 317

Hospital gangrene, Wuertz's views

regarding, 469
Hospitals in the Middle Ages, 219,

235
H6tel-Dieu at Lyons founded in the

6th century, 236, 450
H6tel-Dieu at Paris over-crowded

in early part of 16th century

(Fig.), 452
Hrabanus Maurus, Abbot of Fulda

Monastery, 241
Hugo Benzi (Hugo of Siena), 312
Hugo of Lucca, 275
Hydrotherapy at the Cos Asclepieion,

54
in the treatment of gout, 129
Hygieia, daughter of Aesculapius, 50
Hyoscyamus, when first used for di-
lating the pupils, 157
Hyrtl, Joseph, 311, 356, 532

Iateeia, or small private hospitals, 68
Iatrochemists and iatrophysicists

in 17th century, 366
Ibrahim, pupil of George Bakhtichou,

206
Idea morbosa (Van Helmont), 399
Ileo-caecal valve, discovery of, 350
Iliad and Odyssey, references in, to

medicine, 47
India, ancient, rich in skilful sur-
geons, 35
India, great mortality in, from bites
of venomous serpents, 64
the medicine of, 31
Ingrassia, 349
Innocent XI., Pope, 392
Inoculation against small-pox prac-
ticed by the Chinese in the 11th
century, 43
Intention, healing by first, 277
Intestine, wounds of, 255, 459
Ionian School of Philosophy, 72
Ipecacuanha, discovery of, 408, 409
Isaac, son of Honein, 215

57'2

GENERAL INDEX

Isis, 19

IsoLA San Bartolommeo, 51
Israelites, medicine of the, 26, 27
IssA BEN Chalata, 205
Itinerant lithotomists, 549

J

Jacobus Psychrestos, 201

Jalap, 395

Jamerius, author of "Chirurgia Ja-

mati," 255
Janiscus, son of Aesculapius, 50
Japanese physicians, modern, 45
Jardin-du-Koi, 540
Jaso, daughter of Aesculapius, 50
Jean de Vigo, 472, 473
Jewish medical students, numerous

at Montpellier, 265
John of Arderne, 516

of Capua, 261

of Gaddesden, 305, 516

of Salisbury, 264

the Grammarian, of Alexandria, 185
Journalism, medical, beginnings of,

545
Julian the Apostate, Koman Em-
peror, 236, 435
Jusserand, 306

K

Kerckring, Theodob, 359

King, Edmund, 408

Kitab al-kullidschat (="Colli-

get"), title of Averroes' treatise,

229
Koelliker, 455

Laboulb^ine, comments on Sydenham,

425
Labyrinth of temporal bone, 80
Lancisi, Giovanni Maria, 349, 391
discovers copper plates intended for

Eustachius' "Anatomy," 392

Lanfranchi, 282, 284

Languages, learned, importance of

acquiring a knowledge of them,

271
Lanolin, described by Dioscorides in

A. D. 100, 318
Lapeyronie, Franqois de, 531
Laryngoscopy, direct, mentioned by

Savonarola, 313
Latin, barbaric, 262, 300

commonly employed by teachers of

medicine in 16th and 17th cen-
turies, 369
habitually spoken at Oxford and

Cambridge in 17th century, 424
Laudanum, Sydenham 's liquid,

formula for, 424
Laueea Anglica, title of treatise

written by Gilbertus Anglicus,

305
Laxatives, a term originated by the

Methodists, 133
Laxum and strictum, 130
Le Clerc, Daniel, 73, 171
Le Clerc, Lucien, 217
Leech lodged in the naso-pharynx,

397
Leeches, therapeutic employment of,

first mentioned by Themison, 133
Leeuwenhoek, Anton van, 360
Leg, amputation of (Fig.), 463
Leibnitz, 363
Leonides, 201
Leonine versification, 251
Levret, 539
Libraries, public, seventy possessed

by Spain during the 12th century,

232
Liebreich, originator of the term

"lanolin," 318
Ligatures applied to blood-vessels by

Archigenes in the early part of

2d century, 143
employment of, by Jean de Vigo,

in 1460, 473
used on amputation stumps, 519

GENERAL INDEX

573

LiNACRE, Thomas, 416

founded two "lectures of physick"

at Oxford, 417
instrumental in securing the foun-
dation of the College of Physi-
cians at London, 417

Liquor balsamicus, 357

LiTHONTRiPSY, Giovanni de Eomanis
supposed to be the inventor of,
474

LiTHOTOME OP FRilRE C6mE (Fig.),

553

lithotomists, itinerant, 490, 549
Lithotomy, suprapubic, 495
LiTHOTRiTY practiced first by Beni-

veni in the 15th century, 498
Louis de Bourges, First Physician to

Francis I., 414
LouvAiN, University of, 345
Lower, Richard, 408
Lucius Verus, Roman Emperor, 165
Lucrum neglectum, probable mean-
ing of the expression, 353
Luke, "the beloved physician," 30
LuTETiA, Gaul, the present city of

Paris, 435
Luther, Martin, a believer in the

"black art," 322
Lymphatics, intestinal, 385
Lyons, France, founding of the
Hotel-Dieu in that city (6th cen-
tury), 236

M

Machaon and Podalirius, sons of
Aesculapius, 47, 50

Magati, Cesare, 529

Maggi, Bartolommeo, 473

discoverer of the fact that a bullet
is not hot at moment of inflict-
ing a wound, 513

Magical remedies, 197

Magnus, disciple of Athenaeus, 142

Magreb, 218

Maimonides, esteemed the greatest
Jew after Moses, 230

Malevolent spirits, capable of pro-
ducing disease, 8
Malpighi, 360, 361
Manardus, Johannes, 389
Manfred, King of Sicily, 262

founds a university at Naples in
1258 A. D., 257
Manuscripts, medical, transcribing
of, at Monastery of Saint Gall,
244
Marc Antonio della Torre, 339
Marcus Aurelius, Roman Emperor,

165
Marianus Sanctus, 474
Mariotte, Edme, 546
Martyrdom of Christian physicians,

180
Master of Medicine, grade of, 304
Materia medica, early Greek, 158

first modern treatise on (1447), 320
Mauriceau, Francois, 537
Maurus, teacher of medicine at Sa-
lerno, 245
Mayerne, Turquet de, 547
Meaux Saint-Marc, translator of
* ' Schola Salem itana ' ' into
French, 250
Mediastinitis, case of, 228
Medical teaching in Ancient Greece,
70, 85
in the Asclepieia, 69
Medical treatises, Greek, destruc-
tion of, in Rome, during the 5th
century, 185
Medicine, beginnings of a rational
- system of, 67
development of different sects, after

the death of Hippocrates, 101
evolution of, as affected by the

Arab Renaissance, 203, 233
God of, 50
influence of the Italian Renaissance

upon, 260
mediaeval, 191

practice of, at Rome, in century
preceding Christian era, 117

574

GENERAL INDEX

pre-Homerie period of, in Greece,

46
relation of monasteries to, 238
slowness of development of, 3
Medicine man of the Indian tribes

the earliest type of the physician,

8
Medina worm discovered by Abul-

casis, 233
Membrana Euyschiana, 357
Menelaus wounded at siege of Troy,

48
Menocritus, physician, honored by a

marble column in Greece, 99
Mekcuriade, teacher of medicine at

Salerno, 245
Mesopotamia, medicine in, 11
Mesu^, John, the Elder, 209
Metasyncrisis, a term originated by

Thessalus, 136
Methodists, school of the, 129, 138,

149
Meyer, Ernest von, 400
Meyer- Steineg, of Jena, Germany,

16, 52, 53, 68, 120, 129, 134, 142
Michael Scotus, 262
Microscopic anatomy, first begin-
nings of, 360, 362
Migraine relieved by arteriotomy, 470
Mikrotechne of Galen, 248
Minderer, Eaymond, 407
Mineral waters employed exten-
sively by the ancients in the form

of baths, 157
MiRACH, 521
MiRFELD, John, 306
MisoPOGON, title of satire written by

Julian the Apostate, 436
Mithridates, 127

Mithridaticum, composition of, 112
Mixtum, term employed by the

Methodists, 131
Mommsen, 235
Monasteries in the Middle Ages, 181,

235
relation of, to medicine, 238

MONDEVILLE, Henri de (Fig.), 287,
288, 289, 291

MoNDiNO, the anatomist, 274, 280, 312,
332

Monks obliged to practice medicine
during the Middle Ages, 141, 154

Monte Cassino, founding of Bene-
dictine monastery on, 238, 239

MoNTPELLiER, Medical School of, 264,
292, 332

Morbus gallicus, 543

Mosaic i^aws, the, related particu-
larly to social hygiene, 26

MoscHiON, pupil of Soranus, 139

Motassem, Caliph, 210

moxae, moxibustion, 44

Murphy 's button, Pf olspeundt 's
(15th century) prototype of, 459

Musa, Antonius, physician of Em-
peror Augustus, 129

MusANDiNUS, 245, 254

MusuLMANS as zealous as the Chris-
tians in establishing hospitals,
237

N

Naaman's so-called LEPROSY Cured

by the prophet Elisha, 27
Namtar, the special demon of the

Plague, 13
Naples, university established at, in

1258 A. D., 257
Nasal cavity, illuminating the, 482
Neo-Latin, 262
Neolithic age, state of medical

knowledge during the, 9
Nepenthes, 49
Nerves, wounds of, comments of

Guy de Chauliac upon, 302
Neuburger, Max, 24, 41, 51, 84, 132,

222, 228, 231, 249
Newton, Sir Isaac, 546
NiCAisE, Edouard, 228, 263, 282, 287,

300
Nicholas, the monk, sent by the

Emperor Eomanus to Cordova as

an interpreter of Dioscorides, 226

GENERAL INDEX

575

NicoLAUS Mybepsus, 318

NicoLAUS Praepositus, Antidotarium
of, 253

Nicotine, the alkaloid found in
tobacco, 395

NoESA FAMILY, Celebrated as opera-
tors for the radical cure of hernia,
482

NucK, Anton, the anatomist, 359, 439

NuFEE, Jacob, 534

Oath, Hippocratic, 71

Obstetric methods, rational, of

Soranus, 138, 139
Obstetrical forceps, 535
Obstetrics, practice of, in ancient

Egypt, 17
Odyssey, reference to drugs in the,

18
Oil of St. John's wort, 522
OiSYPUM (lanolin), first described

by Dioscorides (100 A, D.), 318
Old Testament, medicine of the, 26
Oleum Hyperici, 522
Onasilos, a physician, bronze tablet

in honor of (5th century B. C),

found in Island of Cyprus, 99
Opedeldoch, 404
Ophthalmologists, early, 115
Ophthalmology, important contri-
butions to, 546
Opium, probably the drug referred to

by term "nepenthes," 49
proper manner of obtaining, first

described by Scribonius Largus,

155
Sydenham's opinion with regard to

the value of, 424
Oporinus, Paracelsus' assistant, 404
Ordronaux, John, 250, 252
Oribasius, 191
Oriental medicine, 11
Osiris, or Serapis, 19
Over-eating, according to the ancient

Egyptians, is the cause of the

majority of diseases, 22

Padua Medical School, 267, 352

Pagel, 57

Palermo, Sicily, a great centre of

literary activity, 261
Panadoes, how prepared, 443
Panakeia, daughter of Aesculapius,

50
Pancreas, outlet duct of, discovered

in 1641, 358
Paper, invention of, 328
Papin, Denis, 547
Paracelsus, 369, 401, 405, 465

monument in honor of, at Basel, 406
pharmaceutical preparations of, 404
sayings of, 403
treatises published by, 403
Paracentesis abdominis, 110, 124
Paramirum, title of Paracelsus' prin-
cipal treatise, 403
Parchment invented at Pergamum

in 3d century B. C, 101
Par6, Ambroise (Figs.), 404, 499,
500, 502, 515
abandons use of boiling oil, 503
arrests bleeding from divided blood-
vessels by use of ligatures, 512
bitter jealousy shown by his con-
temporaries, 501
charge of plagiarism against him

not sustained, 514
devises artery forceps and other

surgical apparatus, 512
exarticulation of elbow joint per-
formed by hiiji, 508
some of his sayings, 500, 501
summary of his more important

achievements in surgery, 513
treatise on surgery not published
in English until 1577, 518
Paris Medical School, 282
Parmenides, 73
Parrenin, Father, Jesuit missionary,

541
Pason (= Apollo), who invented the
art of medicine, 18

576

GENERAL INDEX

Pas SAVANT, Dean of the College de

St, Come at Paris, 284
Passionakius, title of Gariopontus'

treatise, 247
Pathology, Femel's scheme of, 415

views held by Hippocrates, 86
Pathology, internal, 389
Patroclus dresses the wound of

Eurypylus, 49
Paul, the Apostle, bitten by a poi-
sonous snake on the Island of

Melita, 29
Paulus Aegineta, 199, 227, 318
Pecquet, Jean, rediscovers thoracic

duct (in a dog), 384
Pericardium, abscess in the, Aven-

zoar refers to its actual occur-
rence, 229
Periodeuts or ambulant physicians,

75
Persians, the ancient, medicine of,

25
took very little interest in surgery,

26
Peter the Great purchases Euysch's

anatomical collection, 356
Petroncellus, a teacher of medicine

at Salerno, 245
Peyer, Johann Conrah, 359
Pfolspeundt, Heinrich von, 458, 460
Pharmacist, early use of the term,

316
Pharmacology, earliest treatise on,

published by Dioscorides in 77

A. D., 158
Pharmacopoeia, modern term for

antidotariimi, 319
Augsburg, compiled by Minderer,

407
modern, beginnings of, 547
of India, very rich, 33
Pharmacy, in its infancy, 315

first regularly established in the 8th

century, 318
Pharmakon, term employed by Galen

for a remedial drug, 316
Philinus of Cos, 111

Philosophers' stone, 321

Philosophy, schools of, in Greece
and its colonies, 72

Physicians, consultation of (Fig.)>
457
honored publicly in ancient Greece,

98, 99, 100
more highly esteemed than sur-
geons in 14th century, 304
suffered martyrdom for their Chris-
tian faith, 180

Physiology, human, views held by
Hippocrates, 86

PiETRO d'Abano, 266

Pineau family, lithotomists, 549

Pini, anatomical draughtsman, 348,
392

Pitard, Jehan, Surgeon of Louis IX.,
448, 530

Pitcairn, Archibald, 367

Plague at Athens, history of, by
Thueydides, 96

Plague, the, avoidance of, by Galen,
164

Plants, medicinal virtues of, 157

Platearius, John and Matthew, teach-
ers of medicine at Salerno, 245

Plato, 73, 78

views of, with regard to women
physicians, 77

Platter, Felix, 336, 396, 455

early experiences at Montpellier,
332

Pleurisy, Boerhaave's manner of
treating it, 444

Pliny the Elder, 155

Pneuma, or breath, plays the most
important role in the mechanism
of life, 108
or vital spirit, 141

Pneumatism not popular with the
physicians of Kome, 142

Pneumatists, the, 141

Podalic version, 535, 537

Podalirius, 47

Poisonous snakes, loss of life caused
by the bites of, 64

GENERAL INDEX

577

PoLYBTJS, son-in-law of Hippocrates,
82

Pompeii, physicians' houses disin-
terred at, 315

Pons Varolii, 350

Pores, system of, for conveyance of
tissue juices, 122

Portal, Paul, 539

Poultices, too free use of, condemned,
467

Power, D'Arcy, 307

Pbactica chirurgiae of Eoger, 254

Practica oculorum of Benevenutus
Grapheus, 256

Pbactica of Bartholomaeus, 248

Practica of Cophon the Younger, 249

Practitioners, improper behavior of,
in the sick room, 193

Praepositus, meaning of the term,
253

Praxagoras of Cos, 103

probably the first to distinguish the
difference between arteries and
veins, 103

Prayer formulae employed by the
Babylonians as protective reme-
dies, 13

Pregnant women, dietetics of, 199

Prehistoric period of science of
medicine, 4

Pre-Homeric period of medicine in
Greece, 46

Prescription writing first employed
about A. D. 1400, 320

Printing, invention of, favored ad-
vance of science of medicine, 328

Priscianus, Theodorus, 192

Proksch, 543

Przymiot, title of early Polish treat-
ise on syphilis, 479

Ptolemies, learning greatly pros-
pered under their reign, 100

Ptolemy Euergetes, or Physcon,
116

Pulse, meaning of, according to
Athenaeus, 142

PuLSiFic power of ARTERIES (Galen),

381
Purkinje's bone-corpuscles, 362
Puschmann, 70, 107, 196, 232, 257,

311, 365, 394
Pyaemia, Wuertz's views regarding,

469
Pythagoras, 73, 74

medical doctrines propounded by,

147
Python, Aesculapius represented in

the presence of a, 65

Quintessences of Paracelsus, 405
QuiNi'US, one of Galen's teachers, 162

Eabelais, FRANgois, celebrated hu-
morous writer, was a physician,
451

Eabisu, the demon who causes dis-
eases of the skin, 13

Kaphael 's celebrated painting
showing Plato and Aristotle, 102

Eational system of medicine, be-
ginnings of, in Greece, 67

Eecipes, books of, take the place of
physicians in Eome, 117

Eed-hot cautery iron too freely used
for arresting bleeding, 466

Eefraction, researches of Alhazen in
regard to, 233

Eegimen sanitatis Salernitanum,
246
Arnold's commentary on, 294

Eelios, saintly, universal faith in
their power to heal diseases, 241

Eemedial agents, genuine, em-
ployed in Babylonia, 13

Eemedies, household, Cato's collec-
tion of, 123

Eenaissance, influence of, upon pro-
gress of medicine in Western
Europe, 259

Eenan, Ernest, 229, 231

578

GENERAL INDEX

Eenzi, db, on books written by physi-
cians at Salerno, 246

Eepekcussion, 526

Eespiration, physiology of, accord-
ing to Erasistratus, 108
according to Aretaeus, 144

Eete Malpighi, 361

Ehazes, illustrious Persian physician,
219, 318

Ehinoplasty in Italy in the 15th
century, 459

Ehodion, 533

ElOLAN, J., 360

Eoesslin, Eucharius, 533

Eogek's Peactica, the oldest treatise
on surgery written in Italy dur-
ing the Middle Ages, 254

EOKITANSKY, the famous Viennese
pathologist, advice of, to those
about to study medicine, 3

EoLAND OF Parma, 254, 279

EOMAN PHYSICIANS, of foreign birth,
awarded rights of citizenship by
Julius Caesar, 130

EoMANO Pane publishes first account
of discovery of tobacco, 395

EoME, state of medicine at, after the
death of Asclepiades, 129

EOSA ANGLICA, title of treatise written
by John of Gaddesden, 306

EoussET, Feanqois, 535

EoYAL Society of London, founding
of, 363

EuDBECK, Olaus, 358, 385

EUFUS OF Ephesus, 145, 146

EuYSCH, Friedrich, the anatomist,
356, 358

Sabour ben Sahl, 209

Sage femme, possible origin of the

term, 247
Saint Bartholomew 's Hospital,

London, 524
Saint Basil, founder of a hospital at

Caesarea, 236

Saint C6me, College de, 490
Saint Cosmas and Saint Damian,

Brotherhood of, 530
Saladin of Ascolo, author of first

modern treatise on materia med-

ica, 320
Saladin, Sultan of Egypt, 225
Salamanca, University of, 346
Salerno Medical School, 243, 244,

265
Women teachers at, 245
Saliceto, William of, 277
Salmouih ben Bayan, a distin-
guished pupil of the Djondisabour

school, 210
Salving degli Armati of Florence,

reputed inventor of spectacles,

297
Sanctoeius Sanctoeinus, 368
Sandwith, Dr. F. M., concerning the

most ancient surgical implements

thus far discovered, 9
Sanguification, Galen's theory of,

385
Sanitary science in the 15th century,

314
Sapienza, University of, at Eome,

391
Saesapaeilla, 395

Savonarola, Giovanni Michele, 313
Schielhans, nickname of Hans von

Gerssdorff, 460
Schneider, Conrad Victor, 359
School of Saleeno, title of poem, 250
Schools, significance of the term, 74

SCOTUS OE SCOTTUS, 262

ScEiBONius Largus, 155, 413
Sects in Medicine, 101, 147, 149
Septicaemia, Wuertz's views regard-
ing, 470, 471
Serapion the Elder, 210
Serapis or Osiris, 19
Serpent, significance of the, in the
statues and votive tablets ex-
posed to view in the Aesculapian
temples, 62

GENERAL INDEX

579

Servettjs, Michael, 375

on the circulation of the blood, 376

Shoulder, dislocation of, cured by
Gabriel Bakhtichou, 207

Simon Januensis, 261

sismondi, the historian, 116

Skull, fractures of, 286, 476

Slaves sold by Eomans when they
became old and feeble, 235

Sleep-walking, instance of, narrated
by Alderotti, 273

Small-pox described by Herodotus,
142
earliest treatise upon, 220
Gaddesden 's successful treatment

of, 306
prophylactic inoculation against, 43

Smith, Sir William, 103

Snake, poisonous, treatment of bite
by, 110

Snakeroot, an antidote -for poisoning
by the bite of a snake, 7

SoBiESKi, King of Poland, purchases
Euysch's second anatomical col-
lection, 358

Social hygiene, the Mosaic laws re-
late particularly to, 26

Socrates, 73

Soporific sponges, 253

SoRANus of Ephesus, 138, 139, 159
rational obstetric methods of, 139

Soul, spirit of the, 291

Soul, the, is the blood, according to
Servetus, 376

Spain, medicine flourished in, during
the 10th century, 226

Spanish surgeons of the 16th cen-
tury, 484

Specialization in medicine, 114

Spectacles, use of, first mentioned
by Gordonius (A. D. 1285), 297

Speculum, aural, employed by Jean
de Vigo, 473
majus, of Vincent Beauvais, 270
vaginal, of Paulus Aegineta, 201

Spine, curvature of, 313

Spirit, the, 291, 374
disorders of, 141
of Mindererus, 407
Splenia, 526
Splints made with bundles of straw,

304
Sprengel, Kurt, 342
Springs, European, in 16th century,

323
Stahl, Georq Ernst, 431
doctrine of animism, 432
his "phlogiston," 433
treatise on "theoria medica vera,"
432
Steno, Nicholas (Niels Stensen),

359
Stibium, 158
Stoics, the, 102

Stone in the bladder, cutting for,
494
Gaddesden 's peculiar method of

treating, 306
method of operating kept a secret
by lithotomists, 447
Strangulated hernia. Franco's op-
eration for, 492
Straton, a skilful gynaecologist, 115
Straw splints, for use in fractures,

304
Strictum and laxum, terms em-
ployed by the Methodists, 130-
Boerhaave adopts the doctrine, 442
Styrus, one of Galen's teachers, 162
Suggestion, power of, over the human

mind, 241
Superstitious beliefs constitute one
, of the most extraordinary char-
acteristics of the human race, 10
Surgeon, characteristics which he

should possess, 285
Surgeons of the long robe, a name
given to members of the College
de St. Come, 448
Surgery, considered a menial occupa-
tion during the Eenaissance
(Fig.), 306, 447
early, in Great Britain, 516, 523

580

GENERAL INDEX

strong prejudice against among

French physicians of the 15th

century, 300

systematic instruction in, first given

at Montpellier in 1597, 448

SuKGicAL OPERATIONS in the age of

primitive medicine, 8
SuSRUTA, celebrated East Indian med-
ical author, 31
swammerdam, john, 356
Sydenham, Thomas, 418

a great sufferer from gout, 421
describes an "inflammation of the

blood," 423
experience with the great epidemic

of the Plague, 421
on the nature of fever, 423
treatises published by, 419
Sylvius (Franz de le Boe), 367, 427
clinical instruction cultivated by

him at Leyden, 428, 429
treatises published by him, 428
Sylvius, the anatomist, 340
Syphilis, 473, 542

poem relating to, 391
Syriac ulcer (known to-day as

pharyngeal diphtheria), 144
Syringe, earliest reference to use of,
to be found in Abuleasis' treatise
on surgery, 227
Syringotome, 313

SzANDALANi, Arabic name for phar-
macists, 318

Tagliacotian operation, the so-called,
478, 480

Taqliacozzi, Gaspare, 478

Talismans, amulets, etc., as means of
protection against evil spirits, 9,
13

Teissir, the, Avenzoar's great medi-
cal work, 228, 230

Telesphorus, son of Aesculapius, 50

Temple priests in ancient Egypt, 17

Temple sleep at the Asclepieia, 57

Temples, Aesculapian, their chief

purpose, 51
Tents, practice of employing, in the

treatment of wounds, condemned,

466
Tesrif, the, written by Abulea-
sis (nz Alsaharavius), 227
Tetanus, traumatic, Lanf ranchi 's

treatment of, 285
Thaddeus Alderotti, 272
Thales, of Miletus, 72
Themison, founder of the sect of the

Methodists, 130
the first to mention the employment

of leaches, 133
Theodoric of Lucca, 276
Theodorus, a disciple of Athenaeus,

142
Thessalus, son of Hippocrates, 82,

133
Thessalus, of Tralles, in Asia

Minor, a prominent Methodist,

133
Thierry de H^Sry, 499
Thigh, amputation of, probably per-
formed in early part of Christian

era, 470
fractures of, 304
Thirty Years ' War, the, 426
Thomas Aquinas, a believer in the

art of the magician, 321
Thoracic duct, 384
Thot or Thout (Hermes), the god,

author of the hermetic books, 18,

19
Thucydides, 96
TiRABOSCHi, 338, 378
Tobacco, 395
Toledo, Spain, richly stocked with

manuscript treasures of Arabic

literature, 261
Tolet, Franqois, 550
tolu, balsam of, 395

TORCULAR HeROPHILI, 105
TORRICELLA, 546
TOSORTHOS, 17

GENERAL INDEX

581

Touching, for the "King's evil,"

527, 528
Tracheotomy performed by Asclepia-

des (90 B. C), 124
revived by Antonio Beniveni in the

15th century, 498
Transfusion of blood, 408
Transmutation of baskr metals

into gold, 321
Trautmann, of Wittenberg, 535
Trephine, circular pattern of, 473
Trephining the skull a very ancient

surgical operation, 9
Wuertz slow in resorting to the

operation, 467
Trikka, Thessaly, 51
Trotula, a teacher of medicine at

Salerno, 245
Tuberculosis, virus of, long-lived,

according to Fracastoro, 390
TuRQUET DE Mayerne, 547
Tydides, who smote Aeneas, 49

U

Ulcers, treatment of, according to
the method of Thessalus, 135

Uroscopy eagerly adopted by charla-
tans in 16th century (Fig.), 412
strongly denounced by Scribonius,
Botallo and others, 413

Utukku, the demon who causes dis-
eases of the throat, 13

Vagbhata, a celebrated East Indian

medical author, 31
Valerius Cordus, 318
Valves, discovery of, in the larger

VEINS, 378

Van Helmont, 398

"archaeus influus" and "archaeus

insitus," 399
characteristic sayings, 400
remarkable remedies manufactured

by him, 399

Van Swieten introduces clinical in-
struction at the University of
Vienna, 431

Varolius, 349

Vein should be opened longitudinally
in venesection, 286

Vena portae, 385

Venesection, Celsus' description of
technical details, 152
quantity of blood that may be with-
drawn, 413
spot from which blood should prefer-
ably be taken, 411

Venous artery (pulmonary vein),
371

Venous blood, function of, 373

Versification employed in medical
treatises, 251

Version, podalic, 535

Vesalius, 340, 342, 345, 347, 370, 374,

ViCQ d'Azyr, 532
Victor III., Pope, 239

ViDUS ViDIUS, 340

ViEussENS, Eaymond, 364
Villalobos, 542
Vincent of Beauvais, 270
encyclopaedia of, 263

ViNDICIANUS, 192

Viper, cases of persons bitten by, 488,

507
Vis conservatrix et medicateix

NATURAE (Stahl), 432
Vital force, Stahl's, 405
Vital spirit, Galen's, 376
Vivisection of criminals utilized at
■ Alexandria, Egypt, for scientific

purposes, 107
Vizir Ali ben Issa founds a great

hospital at Bagdad in A. D. 914,

219
VOLCHER Koyter, 349

w

Water, contaminated, purification
of, by distillation, 305

58^

GENERAL INDEX

of river Choaspes, ready boiled for

use and stored in flagons of silver,

carried by King Cyrus on his

campaigns, 26
Wecker, Johann Jacob, 521
Weight-and-pulley treatment of

thigh fractures, Guy de Chau-

liac's, 304
Wharton, Thomas, 359, 546
William of Saliceto, 277
William the Conqueror a patient at

Salerno, 245
Willis, Thomas, 360, 367, 546
Wine, Galen's use of, in dressing

wounds, 163
proper employment of, according

to Asclepiades, 125
Thalassite, 126
Winter, of Andernach, 340
WiRSUNG, George, discovers outlet

duct of human pancreas, 358
Wiseman, Eichakd, 524
Women instructors in medicine

highly esteemed at Salerno, 246
Women physicians among the Arabs

in Spain, during the 12th cen-
tury, 232
WooDALL, John, 522
Wounds, dry method of treating,

275, 285
too frequent probing of, condemned,

466
Wren, Sir Christopher, 408
WuERTZ, Felix, 465

condemns universal employment of

chemical caustics and the red-hot
iron for arresting bleeding, 466

remarks on pyaemia, hospital gan-
grene and septicaemia, 469, 471

remarks on treatment of penetrating
wounds of abdomen, 469

WUNDAERZTE, 369

Xenodochia, institutions for the care

of slaves, 235
Xenophon, C. Stertinius, 54

Yperman, Jehan, a distinguished
Flemish physician of 14th cen-
tury, 309

Zend-Avesta, the, 25

Zeno, founder of the Stoic philosophy,

103
Zerbi, Gabriel, professional visit of,

to Constantinople, cost him his

life, 337
Zeuxis, organizer of a medical school

at Laodicea, 111
Ziphach, 521
ZiRBUS, 521
ZoPYRUS classified drugs according to

the effects which they produce,

111
ZosiMOS, of Panopolis, 321

r.

R

131

B82

Buck, Albert Henry

The growth of medicine
from the earliest times to
about 1800

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& Medical

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